During the Leipzig Interventional Course 2020 more than 70 interventional and surgical live cases are scheduled to be performed and transmitted to the auditorium.
LINC 2020 live case guide
Find all live cases and live case centers listed below.
CLINICAL DATA
PAOD Rutherford 3, severe claudication right calf,
walking capacity 150m, ABI right 0.65
PTA with DCBs 10/18
Osteoporosis
RISK FACTORS
Arterial hypertension, hyperlipidemia, current smoker (40PY)
PROCEDURAL STEPS 1. Left groin retrograde and cross-over approach
– 0.035'' SupraCore guidewire 190 cm (ABBOTT)
– 7F 40 cm Balkin Up&Over sheath (COOK) 2. Guidewire passage
– Command 18 and Armada 18 balloon (ABBOTT) or
– 0.035'' Radiofocus soft angled guidewire, 260 cm (TERUMO) 3. In case of failure to pass the CTO
– GoBackTM Crossing Catheter (Upstream Peripheral) 4. PTA
– 4.0 – 6.0 mm Armada 35 balloon (ABBOTT)
– Conquest high pressure balloon on indication (BARD) 5. Stenting
– 5.0 or 6.0/150 mm Supera Interwoven Selfexpanding Nitinol stent (ABBOTT)
CLINICAL DATA
Left lower abdominal pain radiating to left proximal thigh; aggravated by menstrual cycle
Painful varicose veins vulva and left thigh
Left-sided venous claudication
IMAGING
Ultrasound & MR findings:
- May-Thurner compression
- Retrograde flow left internal iliac vein
- No evidence for nutcracker anatomy
- Left pudendal vein feeding varicose thigh veins
PROCEDURAL STEPS 1. Local anesthesia left groin, supine position 2. Ultrasound-assisted venous access (common femoral vein), insertion 10F sheath 3. Phlebography / IVUS 4. Sinus obliquus stent (OPTIMED)
PROCEDURAL STEPS 1. Right groin retrograde and cross-over approach
– 0.035'' SupraCore guidewire 190 cm (ABBOTT)
– 7F 40 cm Balkin Up&Over sheath (COOK) 2. Guidewire passage
– Command 18 and Armada 18 balloon (ABBOTT) or
– 0.035'' Radiofocus soft angled guidewire, 260 cm (TERUMO) 3. In case of failure to pass the CTO
– Retrograde approach via left peroneal artery 4. Vessel preparation/ PTA
– 4.0 – 6.0 mm Armada 35 balloon (ABBOTT)
– Conquest high pressure balloon on indication (BARD/ BD) 5. Stenting
– 5.5/120 mm Supera Interwoven Selfexpanding Nitinol stent (ABBOTT)
CLINICAL DATA
54 year old lady, normally fit and well, acute onset left leg pain – actually started in the groin, moved inferiorly, went to see family doctor in am; immediately referred to radiology
IMAGING
US scan shows acute left leg DVT, CTPA clear, CTV images to follow
PROCEDURAL STEPS 1.Prone, 10F sheath 2.Initial very gentle venography – 10 cc of dilute contrast 3. IVUS, then stiff glide wire (Merit Medical) into IVC 4.Deploy VETEX (VETEX Medical) thrombectomy device, cranial to caudal action x 2 5.Aspiration – 8F 55 cm Hockey Stick (CORDIS) +/- 7F 90 cm desitination catheter (TERUMO) 6.IVUS to identify remaining thrombus v underlying lesion 7.Balloon angioplasty BARD/BD Atlas 14 mm diameter, 60 mm long; to 14 atm for 14 seconds 8.Stents 14 - 16 mm diameter (BARD/BD Venovo, or COOK Zilver Vena or MEDTRONIC ABRE or Veniti Vici or Optimed Sinus Venous) 9.Balloon angioplasty BARD/BD Atlas 14 mm diameter, 60 mm long; to 14 atm for 14 seconds 10.IVUS and one final venogram
Case 11 – Chronic occlusion of the abdominal aorta, Leriche-Syndrome
Center:
Leipzig, Dept. of Angiology
Case 11 – LEI 06: female, 59 years (M-P)
Operators:
Andrej Schmidt,
Matthias Ulrich
CLINICAL DATA
PAOD Rutherford 5 left, ulceration Dig. 5 left, ABI right 0.22, left 0.33
Severe claudication both calves, absolute walking capacity 30–50 meters
CT
Chronic, thrombus-containing occlusion of the infrarenal aorta and severe stenosis both iliac arteries
PROCEDURAL STEPS 1. Transbrachial approach
– 6F 90 cm Check-Flo performer sheath (COOK)
– 5F 125 cm diagnostic Judkins Right catheter (CORDIS/CARDINAL HEALTH)
– SupraCore 300 cm 0.035'' guidewire (ABBOTT) 2. Passage of the occlusions
– Stiff angled 0,035'' guidewire, 260 cm (TERUMO)
– Together with 5F 125 cm Judkins Right catheter 3. Bilateral groin access
– 7F 10 cm Radiofocus sheath (TERUMO)
– Snaring of the antegrade guidewire from above into the groin-sheath or
– Into 6F-Judkins-Right 4. PTA/ thrombectomy via the groin access bilateral
– Rotarex 10F thrombectomy (STRAUB MEDICAL)
– SupraCore 300 cm 0,035'' guidewire (ABBOTT)
– Admiral balloon 6.0/120 mm bilateral (MEDTRONIC) 5. Implantation of covered stents
– VBX covered stents for both renal arteries (GORE)
– VBX covered stents bilateral in kissing technique (GORE)
Case 12 – Chronic post thrombotic syndrome left leg
Center:
Galway
Case 12 – GAL 02: female, 51 years (E-C)
Operators:
J. Ward,
Gerard O'Sullivan
CLINICAL DATA
DVT x 3; Factor V Leiden deficiency; venous claudication on hills at 50 m; weight gain 9 kg, no ulcers, minimal oedema when wearing stockings; fully anticoagulated
RISK FACTORS
Factor V Leiden
PROCEDURAL STEPS 1. 3 point access RIJV, L FV, R CFV 2. General anaesthetic, urethral catheter 3. Full anticoagulation 4. Cross lesion using multiple obliques – Cxi (COOK), Rubicon (BSCI); Roadrunner wire (COOK) 5. IVUS to confirm position and to confirm dominant inflow inferiorly 6. Balloon angioplasty – Atlas high pressure (BARD/BD) – straight to 14 mm @ 14 atm for 14 s minimum 7. Stents 14 – 16 mm diameter (COOK Zilver Vena or MEDTRONIC ABRE or Veniti Vici or Optimed Sinus Venous or Bard Venovo) 8. Balloon angioplasty – Atlas high pressure (BARD/BD) – straight to 14 mm @ 14 atm for 14 s minimum 9. IVUS to confirm full stent expansion 10. One final venogram to show rapid flow
CLINICAL DATA
PAOD Rutherford 3, walking capacity 100 m, ABI right 0.49
PTA/stent left SFA 12/2019
RISK FACTORS
Arterial hypertension, hyperlipidemia, former smoker (30PY)
PROCEDURAL STEPS 1. Left groin and cross-over approach
– Judkins Right 5F diagnostic catheter (CORDIS/CARDINAL HEALTH)
– 0.035'' SupraCore guidewire 30 cm (ABBOTT)
– 7F - 40 cm Balkin Up&Over sheath (COOK) 2. Guidewire passage of the occlusion
– 0.018'' Command 18 300 cm (ABBOTT)
– 0.035'' QuickCross support catheter, 135 cm (PHILIPS)
– Exchange to a 0.014'' Floppy ES guidewire 300 cm (ABBOTT)
– Confirm intraluminal position with Vision PV 0.14 IVUS (PHILIPS) 3. Laser atherectomy
– 7F Turbo Power Laser with Turbo Elite 2.3 mm catheter (PHILIPS) 4. PTA with DCBs
– Stellarex 5.0/120 mm or 6.0/120 mm DCBs (PHILIPS) 5. Stenting on indication:
- Tack Endovascular System (INTACT VASCULAR INC.)
Case 13 – Heart failure and post-thrombotic syndrome
Center:
Zürich
Case 13 – ZUE 02: male, 66 years, (P-vM)
Operators:
Nils Kucher,
Dai-Do Do,
F. Baumann
CLINICAL DATA
High-risk PE requiring CPR and systemic thrombolysis following hernioplasty, 03/2019
Complications: active retroperitoneal bleeding, sepsis, renal failure, IVC Optease filter thrombosis with massive bilateral DVT of entire deep veins below the IVC filter
Current medical condition: Dyspnea NYHA II-III, post-thrombotic syndrome with permanent leg swelling and venous claudication (particularly left side)
IMAGING
Echocardiography 11/2019: Normal LV function, normalized RV size and function, no indirect signs of pulmonary hypertension
Ultrasound 11/2019 and Chest-CT 07/2019: Patent common femoral veins, patent external iliac veins, post-thrombotic common iliac veins, occluded infrarenal IVC, patent suprarenal IVC
PROCEDURAL STEPS
Cardiopulmonary exercise test 11/2019: Max VO2: 53%
PROCEDURAL STEPS 1. General anesthesia, urinary catheter, supine position 2. Ultrasound-assisted access from:
bifemoral
– common femoral vein: left 10F sheath, right 16F sheath
right jugular vein
– 10F sheath 3. Angioplasty of iliac veins and infrarenal IVC 4. Extraction Optease Filter 5. Reconstruction IVC and iliac veins
– Venovo stents (BARD/ BD)
Case 18 – Progressive carotid artery stenosis left, high grade bilateral vertebral stenosis
Center:
Berlin
Case 18 – BLN 02: male, 79 years (W-G)
Operators:
Ralf Langhoff,
Andrea Behne
CLINICAL DATA
Stenting of the right carotid artery in 2007 without any restenosis
Known carotid artery stenosis on the left side with rapid progression within 6 months from 60 to 80%
DUPLEX
PSVR >4 m/s left ICA, no restenosis in the right CAS
PROCEDURAL STEPS 1. Transfemoral access
– short 8F TERUMO sheath right 2. Selective engaging of the left CCA
– Weinberg Catheter (COOK) 3. Teleskoping of the left ECA
– Stiff glidewire 260 cm, angled tip (TERUMO)
– 8F Vista Brite TIP IG MP shape guiding catheter (CORDIS) 4. Distal protection
– Filterwire EZ (BOSTON SCIENTIFIC) 5. Predilatation
– Maverick 3.0 x 20 mm balloon (BOSTON SCIENTIFIC) 6. Stenting
– 8 x 25 mm Roadsaver Micromesh stent (TERUMO) 7. Postdilatation
– 5 x 20 mm Emerge balloon (BOSTON SCIENTIFIC) 8. Postprodecural DAS 9. Vessel closure
– Angioseal 8F (TERUMO)
Detailed information will be shown in the video itself!
-
,
Room 3 - Technical Forum
Case 19 – Multifocal SFA lesions and popliteal occlusion, left
Center:
Berlin
Case 19 – BLN 03: male, 59 years (T-S)
Operators:
Ralf Langhoff,
David Hardung
CLINICAL DATA
Stenting of a left side, high-grade CIA stenosis in 2019
Still dramatically impaired walking distance due to popliteal occlusion
ABI: 0.5 left, ABI: 0.9 right
IMAGING
Duplex and Angio show popliteal occlusion and SFA stenosis
PROCEDURAL STEPS 1. Antegrade access
– 6F short Prelude Introducer sheath (Merit medical) 2. Wire passage
– 0.018''Advantage wire (TERUMO)
– Backup: Halberd wire 0.018'' or 0.014'' (Asahi) 3. Support catheter
– Carnelian 0.018'' (BIOTRONIK) 4. Predilatation
– 3 x 150 mm PTA balloon (vessel preparation) 5. P TA in the SFA and popliteal
– Sequent OTW 5 x 150 mm balloon (B.Braun) 6. Focal/ spot stenting of SFA and Politeal artery
– Multi-LOC Stent as needed (6 stents maximum) (B.BRAUN)
or using the new 2-LOC
or 3-LOC in 30 or 40 mm length as a focal stent 7. Postdilation with a standard PTA balloon 8. Vessel closure
– Angioseal 6F (TERUMO)
CLINICAL DATA
PAOD Rutherford 3 right, walking capacity 150m
DCB-PTA right 11/2017, ABI right 0.66
Multiple interventions left SFA (stent, PTA, DCB) COPD
PROCEDURAL STEPS 1. Left groin retrograde and cross-over approach
– 0.035'' SupraCore guidewire 190 cm (ABBOTT)
– 7F 40 cm Balkin Up&Over sheath (COOK) 2. Passage of the occlusion right SFA
– 0.035'' Radiofocus angled stiff guidewire, 260 cm (TERUMO)
– 0.035'' CXC support catheter, 135 cm (COOK)
In case of failure guidewire passage from antegrade: 3. Retrograde approach via distal SFA
– 7 cm 21 Gauge needle (COOK)
– 0.018'' V-18 Control guidewire, 300 cm (BOSTON SCIENTIFIC)
– 4F 10 cm Radiofocus introducer (TERUMO)
– Pacific Plus 4.0/40 mm balloon, 90 cm (MEDTRONIC) 4. Vessel preparation
– Pacific 2.0/120 mm balloon (MEDTRONIC)
– VascuTrak 5.0/120 mm balloon (BARD/BD) 5. Stenting on indication
– 5 mm or 6 mm Biomimics 3D stent (VERYAN MEDICAL)
CLINICAL DATA
Critical limb ischemia right, rest-pain right forefoot
Walking capacity 50 meters, ABI right 0.49
Imaging
Duplex: occlusion of all BTK-arteries
DSA: TPT-occlusion, long occlusions of the ATA and PTA
PROCEDURAL STEPS 1. Antegrade access right
– 6F 55 cm sheath Flexor Check-Flo Introducer Raabe Modification (COOK) 2. Guidewire passage of the TPT
– 0.014'' Command ES (ABBOTT) or
– 0.014'' Winn 200 T (ABBOTT) 3. Atherectomy of the TPT
– TurboHawk SX-C (MEDTRONIC)
potentially also atherectomy of the ATA-origin 4. Balloon dilatation of the TPT and ATA
– Amphirion Deep (MEDTRONIC) 5. Stenting on indication:
- Tack Endovascular System (INTACT VASCULAR INC.)
Case 21 – Symptomatic right carotid artery disease in a patient with known history of cardiovascular disease
Center:
Bergamo
Case 21 – BG 04: female, 69 years, (A-M)
Operators:
Fausto Castriota,
Antonio Micari
CLINICAL DATA
Previous CABG (LIMA to LAD, VG to posterolateral branch) + ascending aorta repalcament (2015)
Previous multiple PCI (the last one in 2017 to LCx artery)
Currently asymptomatic for angina, negative stress echo in 2019
In December 2019 episode of left-sided hemiparesis with full neurological recovery
RISK FACTORS
Hypertension, hypercholesterolemia
IMAGING
DUS: severe right carotid artery stenosis with flow acceleration up to 473 cm/sec
PROCEDURAL STEPS 1. Radial access (6F) 2. Right carotid artery selective cannulation
– IM guiding catheter 3. Support guidewire
– 0.035‘‘ Supracore wire in ECA 4. Sheath placement
– Destination 6F long 90 cm sheath (TERUMO) 5. Filter placement
– Spider FX filter (MEDTRONIC) in RICA 6. Direct stenting
– Roadsaver double mesh stent (TERUMO) 7. Postdilatation
– 5.5 mm Ultraverse balloon (BOSTON SCIENTIFIC)
Detailed information will be shown in the video itself!
-
,
Room 2 - Main Arena 2
Case 15 – Pelvic congestion and post-thrombotic syndrome
Center:
Zürich
Case 15 – ZUE 03: female, 43 years (S-K)
Operators:
Nils Kucher,
F. Baumann
CLINICAL DATA
Pregnancy-induced right-sided iliofemoral DVT 01/2018
Conservative treatment with LMWH and compression stockings
Persistant venous claudication and leg swelling as well as lower abdominal pain with aggravation during menstruation cycle
Endovascular reconstruction of right ilio-femoral veins 11/2019 using Venovo & BlueFlow stents
PRESENT STATE
Follow-up in outpatient clinic 12/2019:
Leg symptoms completely resolved
Lower abdominal pain unchanged
PROCEDURAL STEPS 1. Local anesthesia right jugular vein, supine position 2. Ultrasound-assisted access
– 5F sheath 3. Venography of ilio-femoral stents 4. Selective Valsalva venography left ovarian and parauterine veins
– 5F Kobra catheter (COOK) 5. Selective injection of Aethoxysclerol (3%) foam to parauterine veins during Valsalva 6. Coil embolization of left ovarian vein
– Nester 12 mm coils (COOK) 7. Final venogram to confirm ovarian vein occlusion
PROCEDURAL STEPS 1. Left femoral access
– 7F 25 cm Radiofocus Introducer (TERUMO)
– 0.035'' SupraCore guidewire 300 cm (ABBOTT)
Left brachial approach:
– 6F 90 cm Check-Flo Performer (COOK) 2. Antegrade and retrograde guidewire passage
brachial:
v5F Judkins Right diagnostic catheter 125 cm (CORDIS/CARDINAL HEALTH)
from femoral:
– 5F Multipurpose diagnostic catheter 80 cm (CORDIS/CARDINAL HEALTH)
– 0.035'' stiff angled glidewire, 260 cm (TERUMO) 3. Predilatation and stenting of the aorto-iliac bifurcation
– Ultraverse or Dorado balloon (BARD/BD)
– LifeStream covered stent 8/58 mm bilateral common iliac arteries in kissing-technique (BARD/BD)
– Covera Plus vascular covered stent for the external iliac artery (BARD/BD)
Case 23 – Severe right leg claudication in a patient with history of heavy smoking
Center:
Bergamo
Case 23 – BG 05: male, 69 years (G-Z)
Operators:
Fausto Castriota,
Antonio Micari
CLINICAL DATA
Previous coronary angiogram (abnormal stress test) showing unobstructed coronary arteries
Severe right leg claudication (90 m) much impairing quality of life
Quit smoking 1 year ago
RISK FACTORS
Mild hypertension, dyslipidemia
IMAGING
DUS: flow demodulation in right CFA compatible with iliac occlusion
Angio MRI: right distal common iliac occlusion
PROCEDURAL STEPS 1. Left femoral access (6F) 2. Cross-over approach
– 45 cm Destination sheath (TERUMO) 3. Right femoral access
– Back-up, 4F sheath 4. Lesion crossing from cross-over system
– 0.018‘‘ Control wire or hydrophilic 0.035‘‘ wire (TERUMO) 5. Predilatation 6. Stenting with self-expandable stent
– Everflex (MEDTRONIC) 7. Postdilatation
Detailed information will be shown in the video itself!
Cookie settings
We use cookies so that we can offer you the best possible website experience. This includes cookies which are necessary for the operation of the website and to manage our corporate commercial objectives, as well as other cookies which are used solely for anonymous statistical purposes, for more comfortable website settings, or for the display of personalised content. With the exception of strictly necessary cookies, your are free to decide which categories you would like to permit. Please note that depending on the settings you choose, the full functionality of the website may no longer be available. Further information can be found in our privacy statement and cookie policy.
For more infos on the cookies we use and how you can manage them, please visit our cookie policy.