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LINC Asia-Pacific 2016 live case guide

Find all live cases and live case centers listed below.

Conference day 3

  • - , Room 1 - Main Arena 1

    Case 24 – TAI 01: Right common iliac artery aneurysm

    Center:
    Taipei Veterans General Hospital, Taipei City, Taiwan
    Case 24 – TAI 01: male, 71 years (HSU,T-S)
    Operators:
    • Chun-Che Shih,
    • Po-Lin Chen,
    • I-Ming Chen
    CLINICAL DATA
    Right common iliac artery aneurysm 4 cm
    Hypertension, hyperlipidemia

    PROCEDURAL STEPS
    1. Main body of AAA stent graft (ENDURANT II, MEDTRONIC)
    - 32-16-124 mm from left

    2. Home-made fenestration graft for RIIA
    - 13-13-82 mm iliac limb (MEDTRONIC)

    3. RIIA covered stent
    - 7F 90 cm Flexor Check-Flo Performer from left brachial artery (COOK)
    - 10-59 mm Advanta V12 covered stent (ATRIUM)

    4. Left iliac limb
    - 16-24-82 mm (MEDTRONIC)

    5. Right iliac bridging limb
    - 16-16-82 mm (MEDTRONIC)

    6. Postdilatation
    - Reliant balloon (MEDTRONIC)
    View image
  • - , Room 1 - Main Arena 1

    Case 25 – SGH 01: Chimney EVAS

    Center:
    Singapore General Hospital, Singapore, Singapore
    Case 25 – SGH 01: male, 65 years (CKM)
    Operators:
    • Tze Tec Chong ,
    • Kiang Hiong Tay
    CLINICAL DATA
    Asymptomatic 6.9cm AAA
    Ex-smoker, hypertensive, hyperlipidaemia, chronic obstructive airway disease,
    ischemic heart disease, mulitnodular goitre, chronic kidney disease (baseline sCr 300+),
    anaemia of chronic illness (Hb 7 to 8 g/dl), Ca prostate (conservative treatment)
    Ischemic bowel s/p subtotal colectomy and ileostomy in 2009

    PROCEDURAL STEPS
    1. Bilateral femoral arterial punctures, US guided,
    pre close with Proglide x 2 each side.
    Bilateral brachial arterial punctures, US guided, 6F sheaths

    2. Both renal arteries cannulated from brachial approach with TERUMO glidewire
    and MPA catheter. Exchanged for Rosen wire and 7F x 90cm Destination sheaths
    (TERUMO) to introduce 5x38 mm BeGraft (INNOMED) for renal chimneys

    3. Nellix device introduced from below over Lunderquist wires.
    Test fill endobags with saline followed by angio run
    to confirm good aneurysm seal/exclusion.

    4.Fill endobags with polymer and allow to cure.
    Check for endoleaks. Secondary fill if needed.
    View image
  • - , Room 1 - Main Arena 1

    Case 26 – BPH 03: Acute aortic dissection (stanford type B)

    Center:
    Beijing PLA Hospital, Beijing, China
    Case 26 – BPH 03: male, 55 years
    Operators:
    • Wei Guo,
    • Xin Jia
    CLINICAL DATA
    Acute back pain 20 days ago
    Maximal thoracic aortic diameter 5.0 cm

    RISK FACTORS
    Hypertension, smoking

    PROCEDURAL STEPS
    1. Left brachial access for angiogram

    2. Right femoral access – preclose technique
    - Proglide preloaded (ABBOTT)

    3. Stentgraft implantation
    - 32-26-200 Castor branched stentgraft (MICORPORT)
    View image
  • - , Room 1 - Main Arena 1

    Case 27 – SGH 02: Left brachiocephalic vein occlusion

    Center:
    Singapore General Hospital, Singapore, Singapore
    Case 27 – SGH 02: male, 70 years (DFN)
    Operators:
    • Ankur Patel,
    • Sum Leong
    CLINICAL DATA
    Recurrent left arm swelling
    Diabetic, hypertensive, hyperlipidaemia, ischaemic heart disease.
    End stage kidney disease on hemodialysis via left arm brachiocephalic AVF x 6 years.

    CURRENT STATE
    Had left arm swelling 3 months ago due to left brachiocephalic vein occlusion treated successfully with balloon angioplasty. Now symptoms recurred.

    PROCEDURAL STEPS
    1. Antegrade puncture of left BCAVF, 7F sheath

    2. Lesion crossing
    - 0.035 TERUMO glidewire and 4F Ber catheter
    - Right femoral approach if lesion crossing failed via arm approach.

    3. Angioplasty
    - 14.0/40 mm Conquest balloon (C.R.BARD)

    4. Stenting if poor result
    - Sinus XL stent (OPTIMED)
    View image
  • - , Room 1 - Main Arena 1

    Case 28 – TAI 02: AV graft stenosis

    Center:
    Taipei Veterans General Hospital, Taipei City, Taiwan
    Case 28 – TAI 02: female, 41 years (HSU,T-S)
    Operators:
    • Po-Lin Chen,
    • I-Ming Chen
    CLINICAL DATA
    ESRD s/p PD for 2 years, shifted to HD since 2013/07 due to peritonitis
    Right forearm loop AVG was created on 2013/08. High pressure since 2014/12
    Type 1 DM, hypertension
    Left renal cell carcinoma s/p laparoscopic radial nephrectomy in 2014

    PROCEDURAL STEPS
    1. Antegrade puncture of AV graft
    - 7F 5 cm sheath (TERUMO)

    2. PTA to venous anastomosis and basilic vein with DEB
    - 6/80 mm Admiral (MEDTRONIC)
    - 7/80 mm InPact Admiral DEB (MEDTRONIC)
    View image
  • - , Room 1 - Main Arena 1

    Case 29 – SGH 03: Long segment SFA and ATA CTO

    Center:
    Singapore General Hospital, Singapore, Singapore
    Case 29 – SGH 03: female, 75 years (CEM)
    Operators:
    • Kiang Hiong Tay,
    • Karthikeyan Damodharan
    CLINICAL DATA
    Non healing right big toe ulcer x 3 months
    Diabetic, hypertensive, hyperlipidaemia, ischaemic heart disease with CABG 10 yrs ago
    (EF 50%), end stage kidney disease on hemodialysis
    Toe pressures: right 40mmHg, left 129mmHg
    Duplex scan of right leg showed long segment CTO of upper/mid SFA and anterior tibial

    PROCEDURAL STEPS
    1. Ultrasound guided downhill puncture
    - 6F Britetip sheath

    2. Subintimal crossing of SFA CTO
    - 0.035 TERUMO glidewire and 4F Ber catheter
    - Retrograde popliteal access if antegrade crossing failed.

    3. Angioplasty
    - 6.0/200mm Mustang balloon (BOSTON SCIENTIFIC)
    - Ranger drug eluting balloon (BOSTON SCIENTIFIC)

    4. Subintimal crossing of ATA/DP CTO
    - V18 Control wire and 4F Ber catheter.
    - Pedal plantar loop technique if antegrade crossing failed.

    5. Angioplasty
    - 3.0/150 mm Sterling balloon (BOSTON SCIENTIFIC)
    - Ranger drug eluting balloon (BOSTON SCIENTIFIC)
    View image
  • - , Room 1 - Main Arena 1

    Case 30 – LEI 09: Iliac occlusion left with failed recanalization attempt

    Center:
    University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
    Case 30 – LEI 09: male, 54 years (J-K)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    PAOD Rutherford 3, severe claudication left leg
    ABI left 0.71
    Stenting right common iliac artery 2012,
    Unsuccessful recanalizaiton attempt left CIA 1/2016 elsewhere
    CAD, PTCA 6/2015
    Diabetes mellitus type 2, current smoker

    ANGIOGRAPHY
    Common iliac occlusion left, plaque distal abdominal aorta, stent CIA right patent

    PROCEDURAL STEPS
    1. Left brachial access
    - 7F 90 cm Check-Flow-Performer sheath (COOK)
    Left femoral approach
    - 11F 25 cm Radiofocus II sheath (TERUMO)

    2. Guidewire passage of the occlusion left CIA
    transbrachial:
    - 5F 125 cm Judkins Right Diagnostic catheter (CARDINAL HEALTH)
    - 0.035" stiff angled glidewire, 260 cm (TERUMO)
    left femoral:
    - 5F 80 cm Multipurpose Diagnostic catheter (CARDINAL HEALTH)
    - 0.035" stiff angled glidewire, 260 cm (TERUMO)
    - potentially double-balloon technique

    3. Stenting
    - Sinus aortic stent for the abdominal aorta (OPTIMED)
    - Lifestream 8/57 mm covered stent left CIA (C.R.BARD)
    - Lifestream 8/37 mm covered stent right CIA (C.R.BARD)
    View image
  • - , Room 1 - Main Arena 1

    Case 32 – LEI 10: Popliteal occlusion right, CLI

    Center:
    University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
    Case 32 – LEI 10: male, 57 years (P-K)
    Operators:
    • Andrej Schmidt,
    • Yvonne Bausback
    CLINICAL DATA
    PAOD Rutherford 4, Restpein right foot
    ABI left 0.44
    PTA left SFA and popliteal artery 1/2016
    CEA right groin 2012

    RISK FACTORS
    Diabetes mellitus type 2, current smoker

    ANGIOGRAPHY
    Occlusion distal SFA / Apop artery right

    PROCEDURAL STEPS
    1. Right groin antegrade access
    - 6F 55 cm Check-Flow-Performer sheath (COOK)

    2. Guidewire passage:
    - 0.018" Connect guidewire, 300 cm (ABBOTT)
    - CXC 0,018" 90 cm support catheter (COOK)
    In case of failure:
    - 0.035" stiff angled glidewire (TERUMO)
    - CXC 0,035" 90 cm support catheter (COOK)
    If failure:
    retrograde access via posterior tibial artery

    3. PTA and stenting
    - Armada 35 balloon (ABBOTT)
    - Supera Interwoven nitinol stent (ABBOTT)
    View image
  • - , Room 1 - Main Arena 1

    Case 31 – BPH 04: Right SFA long occlusion and BTK lesions

    Center:
    Beijing PLA Hospital, Beijing, China
    Case 31 – BPH 04: male, 68 years
    Operators:
    • Wei Guo,
    • Xin Jia
    CLINICAL DATA
    PAOD Rutherford 5, gangrene at 4 and 5 toes

    RISK FACTORS
    Diabetes, smoking

    PROCEDURAL STEPS
    1. Left femoral retrograde access
    - 6F 40 cm cross-over sheath (COOK)

    2. Crossing the occlusion
    - 0.018" V-18 Control guidewire, 300 cm (BOSTON SCIENTIFIC)
    - 0.014" PT2 wire (BOSTON SCIENTIFIC)

    3. Retrograde peroneal artery puncture (bailout access)

    4. PTA and proventional stent
    - 4/220 mm SAVVY long OTW Balloon, 130 cm (CORDIS)
    - 6.0/200 mm, EVERFLEX, Nitinol Stent System 120 cm (EV3)
    View image
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