CLINICAL DATA
CLI left 2nd toe gangrene
PAOD Rutherford 5
DM hypertension hyperlipidemia Cr 116
PROCEDURAL STEPS 1. Antegrade access via left groin
- 5F sheath (TERUMO)
2. Antegrade passage of the lesion with hydrophilic wire
- 0.014" COMMAND Extra support wire 300 cm (ABBOTT)
- 2 x 80 Armada 14 (ABBOTT)
3. Retrograde passage of lesion via ultrasound guided DP puncture
- 4F Micropuncture® transpedal set (COOK)
- EDGE ultrasound high frequency probe (SONOSITE)
- 0.018" V-18 control wire, 300 cm (BOSTON SCIENTIFIC)
- 2.6F Angled CXI support catheter, 90 cm (COOK)
4. Predilatation and lesion preparation
- 2.5 x 100 mm Vascutrak scoring PTA catheter (BARD)
5. PTA with DEB
- 2.5 or 3 x 120 mm Lutonix drug-coated balloon (BARD)
Case 13 – Occlusion of left popliteal and tibial arteries
Center:
Beijing Military Hospital 301, Beijing, China
Case 13 – BMH 01: male, 72 years
Operators:
Wei Guo,
Xin Jia
CLINICAL DATA
PAOD Rutherford 4
Rest pain at left foot
Smoking for 30 years
Coronary artery disease
ABI left 0.5; right 0.7
PROCEDURAL STEPS 1. Antegrade access and placement of a long sheath
- 0.035" Radiofocus Terumo angled soft guidewire, 180 cm (TERUMO)
- 6F Flexor Straight sheath, 55 cm (COOK)
2. Passage of the lesion with hydrophilic wire and predilatation
- 0.018" V-18 control wire, 300 cm (BOSTON SCIENTIFIC)
- 4/120 mm Pacific balloon dilatation catheter for POP, 130 cm (MEDTRONIC)
- 2/120 mm DEEP balloon dilatation catheter for PA and PT, 130 cm (MEDTRONIC)
3. Retrograde AT or PA puncture in case of antegrade failure
- 0.018" V-18 control wire, 300 cm (BOSTON SCIENTIFIC)
- 2/80 mm DEEP balloon dilatation catheter, 130 cm (MEDTRONIC)
Case 14 – PEVAR plus distal sandwich technique for infra-renal AAA with RCIA aneurysm
Center:
Chang Gung Memorial Hospital, Taoyuan City, Taiwan
Case 14 – TAO 03: male, 76 years (K-H-C)
Operators:
Kuo-Sheng Liu,
Sung-Yu Chu
CLINICAL DATA
Herniated interveterbral disc with right leg numbness
Infra-renal AAA was incidentally found by CT
Hypertension, previous smoker, gout
Cr 1.32, EF: 70%
CTA
Infrarenal AAA (5.8 x 5.6 cm, od) and RCIA aneurysm (3.9 cm/id) with much mural thrombus
PROCEDURAL STEPS 1. Retrograde access (ultrasound guided puncture) via RCFA and LCFA
- Preclose techniques: Proglide (ABBOTT)
- 8F and 10F sheaths for RCFA and LCFA (TERUMO)
CLINICAL DATA
Left leg claudication PAOD Rutherford 3
DM hypertension left CFA
Endarterectomy right SFA stent
EF 60%
CKD Cr 190
PROCEDURAL STEPS 1. Contralateral cross-over access via right groin
- 0.035" Radiofocus angled soft guidewire, 260 cm (TERUMO)
- 4F Ber II catheter (CORDIS)
- 0.035" Supra Core guidewire, 300 cm (ABBOTT)
- 6F 40 cm long Balkin sheath (COOK)
- CO2 angiography with CO2 Angioset (OPTIMED)
2. Passage of the lesion with CTO device and predilatation
- Truepath CTO device (BOSTON SCIENTIFIC)
- 0.018" Rubicon catheter (BOSTON SCIENTIFIC)
- 0.018" V-18 control wire, 300 cm (BOSTON SCIENTIFIC)
- Sterling balloon 4 x 120 (BOSTON SCIENTIFIC)
3. Treatment with DEB and postdilatation
- Ranger drug eluting balloon 5/6 x 120 (BOSTON SCIENTIFIC)
- Mustang balloon 6 x 40 (BOSTON SCIENTIFIC)
4. Stenting on indication
- Spot-stenting with Innova stent (BOSTON SCIENTIFIC)
CLINICAL DATA
Left leg claudication PAOD Rutherford 3
DM hypertension hyperlipidemia PCI 2011 EF 55% Cr normal
Left SFA stent in subintimal spot stent Taiwan late 2014
PROCEDURAL STEPS 1. Contralateral cross-over access via right groin
- 0.035" Radiofocus angled soft guidewire, 260 cm (TERUMO)
- 4F Ber II catheter (CORDIS)
- 0.035" Supra Core guidewire, 300 cm (ABBOTT)
- 6/8F 40 cm long Balkin sheath (COOK)
2. Antegrade passage of the lesion with hydrophilic wire
- 0.018" V-18 control wire, 300 cm (BOSTON SCIENTIFIC)
- 0.035" Radiofocus angled soft guidewire, 250 cm (TERUMO)
- 4F Ber II catheter (CORDIS)
3. Retrograde puncture of occluded stent in event of antegrade failure
- 0.035" Radiofocus angled soft guidewire, 250 cm (TERUMO)
- 4F CXI support catheter, 90 cm
4. Mechanical thrombectomy and debulking
- Predilatation with Powercross 3 x 120 balloon (COVIDIEN)
- 6/8F Rotarex (STRAUB MEDICAL)
University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
Case 17 – LEI 06: male, 56 years (T-N)
Operators:
Matthias Ulrich,
Andrej Schmidt
CLINICAL DATA
Severe claudication left calf
Walking capacity 150 meters
COPD
CT
Long SFA-occlusion left
ABI
0.62 left
PROCEDURAL STEPS 1. Access right groin and cross-over approach
- 5F IMA-catheter (CORDIS)
- 0.035" SupraCore guidewire 200 cm (ABBOTT)
- 6F-40 cm Balkin Up&Over sheath (COOK)
2. Passage of the occlusion and PTA
- 0.035" angled stiff glidewire, 260 cm (TERUMO)
- 0.035" Seeker support catheter, 135 cm (BARD)
- 5.0/250 mm Vascutrak balloon (BARD)
3. PTA with Drug-Coated balloons and stenting on indication
- 5/150 Lutonix DCB (BARD)
- LifeStent (BARD)
CLINICAL DATA
Right leg claudication PAOD Rutherford 3
DM hypertension hyperlipidemia EF 69% Cr normal
Right CFA endarterectomy and patch Oct 2014 failed antegrade attempt
PROCEDURAL STEPS 1. Antegrade access via right groin
- 6F sheath (TERUMO)
2. Passage of the lesion with hydrophilic wire
- 0.018" V-18 control wire, 300 cm (BOSTON SCIENTIFIC)
- 4F Ber II catheter (CORDIS)
3. Retrograde PT access in event of antegrade failure
- 4F Micropuncture® pedal access set (COOK)
- 0.018" V-18 control wire, 300 cm (BOSTON SCIENTIFIC)
- 2.6F CXI support catheter, 90 cm (COOK)
4. Predilatation and lesion preparation
- 5/6 x 120 mm Fox SV (ABBOTT)
- 5/6 x 40 mm Armada 35 (ABBOTT)
5. Stent implantation and postdilatation
- SUPERA 5 mm x 150 stent (ABBOTT)
6. Consider treatment of runoff
- 0.014" COMMAND extra support wire, 300 cm (ABBOTT)
- 2.5 x 15 NC TREK balloon for PT lesion (ABBOTT)
7. Implantation of bioabsorbable scaffold
- 2.5 x 28 ABSORB bioabsorbable vascular scaffold/BVS (ABBOTT) for TPT and PT lesion
CLINICAL DATA
PAOD Rutherford 3
DM hypertension hyperlipidemia EF 60% Cr 140
PROCEDURAL STEPS 1. Contralateral cross-over access via right groin
- 0.035" Radiofocus angled soft guidewire, 260 cm (TERUMO)
- 4F Ber II catheter (CORDIS)
- 0.035" Supra Core guidewire, 300 cm (ABBOTT)
- 7F 40 cm long Balkin sheath (COOK)
2. Passage of the lesion with hydrophilic wire and filter placement
- 0.014" PT2 MS 300 cm guidewire (BOSTON SCIENTIFIC)
- 4F Ber II catheter (CORDIS)
- 0.018" Trailblazer support catheter (COVIDIEN)
- Spider FX 3 mm into ATA (COVIDIEN)
3. Directional arterectomy
- Turbohawk (COVIDIEN)
4. Treatment with DEB
- In.Pact Pacific 5/6 x 120 mm DEB-balloon (MEDTRONIC)
University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
Case 20A – LEI 07A: male, 62 years (P-R)
Operators:
Andrej Schmidt,
Matthias Ulrich
CLINICAL DATA
CLI wih ulcerations both feet,
PTA right SFA and BTK-arteries Feb 2015
CAD with PTCA 2013
Renal insufficiency, GFR 64 ml/min
ANGIOGRAPHY
During PTA right leg:
severely calcified distal SFA- and Apop-occlusion left
ABI: > 1.3
PROCEDURAL STEPS 1. Antegrade approach left groin
- 7F-55 cm Ansel sheath (COOK)
2. Guidewire passage
- 0.035" stiff angled glidewire 260 cm (TERUMO)
- 0.035" Seeker support catheter 90 cm (BARD)
3. In case of antegrade failure retrograde approach via the severely diseased proximal ATA
- 7 cm 21 Gauge needle (COOK)
- 0.018" Connect 300 cm guidewire (ABBOTT)
- CXC 0.018" 90 cm support catheter (COOK)
4. PTA of the lesion
- 5/40 and 6/40 Armada 35 (ABBOTT)
In case of residual stenosis high-pressure balloon:
- 6/20 mm Conquest (BARD)
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