Conference day 3

• 8:00 - 8:20, Room 1 - Main Arena 1

  Case 52 – ABT 01

  Center:

  Abano Terme

  Case 52 – ABT 01

  Operators:

  • Marco Manzi,
  • Cesare Brigato,
  • Efrem Gomez Jabalera

  Detailed information will be shown in the video itself!
• 8:00 - 9:00, Room 3 - Technical Forum

  Case 67 – Long, moderately calcified SFA-occlusion left

  Center:

  Leipzig, Dept. of Angiology

  Case 67 – LEI 26: male, 61 years, (K-W)

  Operators:

  • Sven Bräunlich,
  • Matthias Ulrich

  CLINICAL DATA
  PAOD Rutherford 3, claudication left calf, walking capacity 150m, ABI left 0.63
  
  RISK FACTORS
  Hyperlipidemia, current smoker
  
  PROCEDURAL STEPS
  1. Right groin and cross-over access
  – IMA-diagnostic 5F catheter (CORDIS/ CARDINAL HEALTH)
  – 0.035'' angled soft Radiofocus guidewire, 190 cm (TERUMO)
  – 0.035'' SupraCore guidewire, 190 cm (ABBOOTT)
  – 6F Balkin Up&Over sheath, 40 cm (COOK)
  2. Passage of the occlusion left SFA
  – 0.018'' Advantage guidewire (TERUMO)
  – 0.018'' CXI support catheter (COOK)
  in case of failure:
  – GoBack crossing catheter (UPSTREAM PERIPHERAL)
  3. Vessel preparation left SFA with scoring balloon
  – UltraScore 5.0/300 mm balloon (BARD/BD)
  4. Primary stenting
  – 6 mm Eluvia DES (BOSTON SCIENTIFIC)
  

  View image
• 8:20 - 8:50, Room 2 - Main Arena 2

  Case 62 – MUN 05

  Center:

  Münster

  Case 62 – MUN 05

  Operators:

  • Martin Austermann,
  • S. Mühlenhöfer,
  • Y. Khatadba

  Detailed information will be shown in the video itself!
• 8:49 - 9:09, Room 1 - Main Arena 1

  Case 53 – CTO of the right anterior tibial artery, CLI-patient

  Center:

  Leipzig, Dept. of Angiology

  Case 53 – LEI 19: male, 76 years (W-M)

  Operators:

  • Andrej Schmidt,
  • Sven Bräunlich

  CLINICAL DATA
  Critical limb ischemia, ulceration dig 2 right,
  restpain and severe claudication right, ABI right 0.2
  PTA/stent right popliteal artery 12/19 with no clinical improvement
  CAD, AMI 2010, CABG 2010
  
  RISK FACTORS
  Arterial hypertension, diabetes mellitus type 2, hyperlipidemia
  
  PROCEDURAL STEPS
  1. Antegrade approach right groin
  – 6F 55 cm sheath (COOK)
  2. Guidewire passage antegrade into anterior tibial artery
  – 0.014'' Command (ABBOTT)
  – 0.014'' PT2 guidewire 300 cm (BOSTON SCIENTIFIC)
  In case of failure: retrograde approach
  3. PTA
  – Vessel preparation – scoring balloon (VascuTrak, BARD/ BD)
  – Lutonix BTK DCB (BARD/ BD)
  4. Stenting on indication:
  - Tack Endovascular System (INTACT VASCULAR INC.)

  View image
• 9:40 - 10:05, Room 1 - Main Arena 1

  Case 54 – Chronic in-stent reocclusion left SFA

  Center:

  Leipzig, Dept. of Angiology

  Case 54 – LEI 20: male, 70 years (P-H)

  Operators:

  • Sven Bräunlich,
  • Johannes Schuster

  CLINICAL DATA
  Severe claudication left, ABI 0.65; walking capacity 100 meters
  Rutherford class 3
  PTA/stenting left CIA and left SFA 07/19
  Stroke 1997
  
  RISK FACTORS
  Heavy smoker (50PY), arterial hypertension, hyperlipidemia
  
  PROCEDURAL STEPS
  1. Right groin retrograde and cross-over approach
  – 8F Balkin Up&Over sheath (COOK)
  2. Guidewire passage
  – 0.018'' Command 18 guidewire, 300 cm (ABBOTT)
  – 0.018'' Quick-Cross support catheter, 135 cm (PHILIPS)
  3. Thrombectomy
  – Rotarex 8F (STRAUB MEDICAL)
  4. PTA with DCBs
  – Ranger DCB 5 mm (BOSTON SCIENTIFIC)
  

  View image
• 10:00 - 11:00, Room 3 - Technical Forum

  Case 68 – ABT 03

  Center:

  Abano Terme

  Case 68 – ABT 03

  Operators:

  • Marco Manzi,
  • Cesare Brigato,
  • Efrem Gomez Jabalera

  Detailed information will be shown in the video itself!
• 10:15 - 10:40, Room 1 - Main Arena 1

  Case 55 – LEI 21

  Center:

  Leipzig, Dept. of Angiology

  Case 55 – LEI 21

  Operators:

  • Sven Bräunlich,
  • Matthias Ulrich

  Detailed information will be shown in the video itself!
• 11:30 - 11:55, Room 2 - Main Arena 2

  Case 63 – PAR 03

  Center:

  Paris

  Case 63 – PAR 03

  Detailed information will be shown in the video itself!
• 12:38 - 12:58, Room 1 - Main Arena 1

  Case 56 – LEI 22

  Center:

  Leipzig, Dept. of Angiology

  Case 56 – LEI 22

  Operators:

  • Andrej Schmidt,
  • Daniela Branzan

  Detailed information will be shown in the video itself!
• 14:06 - 14:32, Room 2 - Main Arena 2

  Case 64 – MUN 06

  Center:

  Münster

  Case 64 – MUN 06

  Operators:

  • Martin Austermann,
  • S. Mühlenhöfer,
  • Y. Khatadba

  Detailed information will be shown in the video itself!
• 14:12 - 14:32, Room 1 - Main Arena 1

  Case 57 – CLI, deep vein arterialization of a "desert foot" right

  Center:

  Leipzig, Dept. of Angiology

  Case 57 – LEI 23: male, 76 years (E-K)

  Operators:

  • Daniela Branzan,
  • Andrej Schmidt

  CLINICAL DATA
  PAOD Rutherford 5, non-healing forefoot ulcerations, mediasclerosis, ABI > 1.4
  PTA right popliteal artery 12/19 and proximal ATA
  Cholangiocarcinoma with metastasis 02/18
  
  RISK FACTORS
  Arterial hypertension, hyperlipidemia, diabetes mellitus type 2
  
  PROCEDURAL STEPS
  1. Right groin antegrade access
  – 7F 55 cm Flexor Check-Flo sheath, Raabe Modification (COOK)
  2. Right distal venous tibial retrograde access
  – 5F sheath Introducer 2¨ (TERUMO)
  3. Arteriography and phlebography to define the optimal level for arterio-venous crossing
  4. Crossing from artery to vein
  – LimFlow Arterial Catheter 7F (LIMFLOW)
  – LimFlow Venous Catheter 5F (LIMFLOW)
  – LimFLow Ultrasound System (LIMFLOW)
  – PT2 0.014'' guidewire to pass from artery into vein (BOSTON SCIENTIFIC)
  – Predilatation with MiniTrek 3.5/20 mm, OTW coronary balloon (ABBOTT)
  5. Guidewire passage through vein and vein preparation
  – PT2 0.014'' guidewire (BOSTON SCIENTIFIC) or
  – Command 18 guidewire (ABBOTT)
  – Push Valvulotome 4F (LIMFLOW)
  – 4.0/120 mm Pacific ballon (MEDTRONIC)
  6. Implantation of covered stentgrafts
  – LimFlow Extension stentgrafts 7F 5.5 mm x 150 mm (LIMFLOW) for vein coverage
  – LimFLow Crossing stentgraft 7F 3.5 x 60 mm (LIMFLOW) for connection artery to vein

  View image
• 15:00 - 17:00, Room 3 - Technical Forum

  Case 69 – ABT 04

  Center:

  Abano Terme

  Case 69 – ABT 04

  Operators:

  • Marco Manzi,
  • Cesare Brigato,
  • Efrem Gomez Jabalera

  Detailed information will be shown in the video itself!
• 15:00 - 17:00, Room 3 - Technical Forum

  Case 70 – Severely calcified CTO of the left distal SFA and left popliteal artery, "pave and crack"-technique

  Center:

  Leipzig, Dept. of Angiology

  Case 70 – LEI 27: male, 73 years (K-W)

  Operators:

  • Andrej Schmidt,
  • Matthias Ulrich

  CLINICAL DATA
  PAOD Rutherford III left, painfree walking distance 100 m, ABI left: 0.45
  Multiple interventions right SFA and popliteal artery, D1-amputation right 10/19
  CAD, ICM (EF 20%), AMI 2001, CABG 2001, ICA-occlusion left
  
  RISK FACTORS
  Arterial hypertension, current smoker, diabetes mellitus type 2, hyperlipidemia
  
  PROCEDURAL STEPS
  1. Right groin retrograde and cross-over approach
  – IMA 5F diagnostic catheter (CORDIS/ CARDINAL HEALTH)
  – 0.035'' soft angled Radiofocus guidewire, 190 cm (TERUMO)
  – 0.035'' SupraCore guidewire 190 cm (ABBOTT)
  – 7F 55 Check-Flo Performer sheath, Raabe Modification (COOK)
  2. Antegrade guidewire passage
  – 0.035'' stiff angled glidewire, 260 cm (TERUMO)
  – CXC 0.035'' support catheter, 135 cm (COOK)
  3. Retrograde guidewire passage
  Access via the proximal anterior tibial artery:
  – 9 cm 20 Gauge Spinal Needle (BD)
  – 0.018'' V-18 Control guidewire, 300 cm (BOSTON SCIENTIFIC)
  – 4F 10 cm Radiofocus Introducer (TERUMO)
  – GoBack crossing catheter (UPSTREAM PERIPHERAL)
  4. PTA and Stenting
  – 5.0/20 mm and 6.0/20 mm Admiral Xtreme balloon (MEDTRONIC)
  – 6.0/20 Conquest non-compliant high pressure balloon (BARD/BD)
  In case of inability to open the balloons fully:
  – Implantation of a Viabahn 6.0/150 mm (GORE)
  – Relining with Supera Interwoven Nitinol stent (ABBOTT)

  View image
• 15:10 - 15:35, Room 1 - Main Arena 1

  Case 58 – LEI 24

  Center:

  Leipzig, Dept. of Angiology

  Case 58 – LEI 24

  Operators:

  • Andrej Schmidt,
  • Johannes Schuster

  Detailed information will be shown in the video itself!
• 15:55 - 16:20, Room 1 - Main Arena 1

  Case 59 – OCT-guided atherectomy of popliteal stent ISR followed by DCB

  Center:

  Münster

  Case 59 – MUN 04: male, 52 years (W-K)

  Operators:

  • Arne Schwindt,
  • Angeliki Argyriou,
  • A. Sohr

  CLINICAL DATA
  1990 Luxation trauma of right knee with emergency distal origin saphenous vein bypass, knee TEP Oct/2018, Sept 2019 Rutherford IV right leg, advanced ante- & retrograde recanalization of chronic occluded popliteal bypass and stent PTA with three 5.5 mm Supera stents
  
  PRESENT STATE
  After symptom free interval recurrent claudication and restpain right leg, CCDuplex shows TOSAKA II ISR of the popliteal vein graft with vmax of 350 cm/sec, drop of ABI from >1 in September to 0.4 right leg January 2020
  
  PROCEDURAL STEPS
  1. Duplex guided antegrade puncture of right CFA, insertion of 5F 10 cm sheath (TERUMO) angiogram of right leg
  2. Change to 7F 40 cm sheath (Destination, TERUMO), placement of 4 mm filter in TP trunc (Spider, MEDTRONIC)
  3. OCT-guided directional atherectomy of ISR with 7F Pantheris (Avinger)
  4. Antirestenotic therapy with Passeo Lux DCB (Biotronik)
  5. Filter recovery and closure of access site with Angioseal VCD (TERUMO) - 10 mm CONQUEST high pressure balloon

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• 16:15 - 16:40, Room 2 - Main Arena 2

  Case 65 – FEVAR for type 5 thoraco abdominal aortic aneurysm

  Center:

  Paris

  Case 65 – PAR 04: male, 85 years

  Operators:

  • Stéphan Haulon,
  • D. Fabre,
  • P. Charbonneau,
  • A. Girault

  CLINICAL DATA
  Lumbar spine surgery for herniated disc (1993)
  Aorto bi-femoral bypass for an infrarenal AAA (1998)
  Bilateral femoral arteries angioplasty and stenting, L CFA endarterectomy (2012)
  Urothelial cancer resected in 2011, colon polypectomy in 2003
  Chronic kidney disease (GFR 48 ml/min), hypertension, dyslipidemia
  
  PRESENT STATE
  ASA 3, ECG: sinus, TTE: LVEF: 65%, normal
  
  PROCEDURAL STEPS
  1. L: Advance 16F 30 cm GORE Dryseal sheath in the LCFA over Lunderquist – 2x 6F-55 cm COOK Ansel sheaths
  100 U/kg Heparin (Target ACT³250)
  L (through one of the 6F): advance long pigtail catheter
  R: 10F sheath/Lunderquist/ dilators up to 20
  2. R: Deployment of proximal TEVAR, just above the celiac trunk
  3. Fluoroscopy to locate fenestrations gold markers
  R: Advanced fenestrated endograft – Aortic angiogram – fenestrated endograft deployment
  4. R: Rosen wire advanced through preloaded catheter – Exchange preloaded catheter for a 6F-90 cm COOK Ansel Shuttle sheath – Exchange Rosen for a Stealcore 0.018- 300 cm wire – Retrieve 6F to the level of the fenestration – Retrieve the 6F dilator – Puncture valve – DAV + TERUMO/Roadrunner through 6F for renal artery catheterisation – Renal angiogram – Exchange TERUMO for Rosen – Retrieve Stealcore wire – Advance 6F into the renal artery – Advance BENTLEY Begraft bridging stent to parking position
  5. Same for controlateral renal artery
  6. L: Through 6F sheath advance BER + TERUMO to catheterize fenestrated endograft lumen – Advance 6F below the fenestration (SMA/CT) – USL + TERUMO/ Roadrunner through 6F sheath to catheterise target vessel (SMA/CT) – Vessel angiogram – Exchange TERUMO for Rosen wire – Advance 6F into target vessel – Advance BENTLEY Begraft bridging stent to parking position
  7. R: Release diameter-reducing ties – proximal and distal attachments – Nose retrieval under fluoroscopy
  8. L: SMA/CT stent deployment (3-4 mm protruding in the aortic lumen) after 6F retrieval – Flare the aortic portion of stent with 10-20 mm balloon – Advance 6F in the SMA/CT stent/angiogram (SMA: exchange Rosen for TERUMO wire)
  9. R: Renal artery stent deployment (3-4 mm protruding in aortic lumen) after 6F retrieval – Flare the aortic portion of stent with 9-20 mm balloon – Advance 6F back into the renal stent – angiogram
  10. R: Remove nose under fluoroscopy / Remove fenestrated device delivery system
  L: Withdraw 6F sheath in 16F – Insert and deploy bifurcated device and iliac limbs
  11. CODA balloon to mold overlaps and distal sealing zones
  Pigtail catheter – Angiogram + non-contrast CBCT

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• 16:45 - 17:10, Room 1 - Main Arena 1

  Case 60 – Calcified occlusion of the left SFA

  Center:

  Leipzig, Dept. of Angiology

  Case 60 – LEI 25: male, 62 years (R-A)

  Operators:

  • Andrej Schmidt,
  • Johannes Schuster

  CLINICAL DATA
  PAOD Rutherford 3 left, walking capacity 100 m, claudication left calf, ABI left 0.57
  PTA of a 8 cm long profunda femoris occlusion right 10/2019 and right SFA 12/19
  CAD, ICM (EF 35%), CABG and aortic valve replacement 09/19, atrial fibrillation, pacemaker 09/19
  
  RISK FACTORS
  Arterial hypertension, hyperlipidemia, current smoker (40PY)
  
  PROCEDURAL STEPS
  1. Right 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. Antegrade guidewire passage
  – 0.035'' stiff angled glidewire, 260 cm(TERUMO)
  – CXC 0.035'' support catheter, 135 cm (COOK)
  3. Retrograde guidewire passage access via occluded SFA
  – 7 cm 18 Gauge needle (COOK)
  – 0.018'' V-18 Control guidewire, 300 cm (BOSTON SCIENTIFIC)
  – 4F-10 cm Radiofocus Introducer (TERUMO)
  – GoBack crossing catheter (UPSTREAM PERIPHERAL)
  4. PTA with normal and high pressure balloons
  – 6.0/ 20 mm Admiral Xtreme balloon (MEDTRONIC)
  – 7.0/ 20 mm Conquest non-compliant high pressure balloon (BARD/ BD)
  5. Stenting
  – In case of inability to open the balloons fully implantation of a Viabahn 7.0/100 mm (GORE)
  – Relining with Supera Interwoven Nitinol stent (ABBOTT)
  – Eluvia drug-eluting stent for proximal SFA (BOSTON SCIENTIFIC)
  

  View image
• 17:25 - 17:50, Room 1 - Main Arena 1

  Case 61 – ABT 02

  Center:

  Abano Terme

  Case 61 – ABT 02

  Operators:

  • Marco Manzi,
  • Cesare Brigato,
  • Efrem Gomez Jabalera

  Detailed information will be shown in the video itself!
• 17:35 - 18:00, Room 2 - Main Arena 2

  Case 66 – MUN 07

  Center:

  Münster

  Case 66 – MUN 07

  Operators:

  • Martin Austermann,
  • E. Beropoulis,
  • Y. Shehada

  Detailed information will be shown in the video itself!