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LINC Middle East 2016 live case guide

Find all live cases and live case centers listed below.

University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany

15 livecase(s)
  • Thursday, April 7th: - , Main Arena

    Case 01 – Total occlusion left common iliac artery

    Center:
    University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
    Case 01 – LEI 01: male, 63 years, (S-F)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    Severe claudication left buttock, thigh and calf, walking capacity 50 meters
    Rutherford class 3
    CAD with PTCA 2008 and 2015
    Former smoker
    Art. Hypertension

    ANGIOGRAPHY
    During PTCA 2015: calcified total occlusion left common iliac artery
    ABI left 0.65

    PROCEDURAL STEPS
    1. Femoral access left side
    - 7F 25 cm sheath (TERUMO)
    Left brachial approach:
    - 7F 90 cm Check-Flo Perfomer Sheath (COOK)

    2. Guidewire passage from brachial
    - 5F 125 cm Judkins Right diagnostic catheter (CARDINAL HEALTH)
    - 0.035" stiff angled glidewire, 260 cm (TERUMO)

    3. Guidewire passage from femoral
    - 5F 80 cm Multipurpose diagnostic catheter (CARDINAL HEALTH)
    - 0.035" stiff angled glidewire, 260 cm (TERUMO)
    - Potentially double-balloon-technique with:Admiral balloon 5.0/40 mm, 135 cm (MEDTRONIC)

    4. Stentgraft implantation bilateral after predilatation
    - LifeStream covered stentgraft (BARD)
    View image
  • Thursday, April 7th: - , Main Arena

    Case 02 – Chronic total occlusion right SFA

    Center:
    University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
    Case 02 – LEI 02: female, 72 years (E-R)
    Operators:
    • Sven Bräunlich,
    • Matthias Ulrich
    CLINICAL DATA
    Severe claudication right calf, walking capacity 100 meters
    Rutherford class 3
    Diabetes mellitus type 2, art. hypertension

    DUPLEX
    Partially calcified SFA-occlusion right
    ABI 0.67

    ANGIOGRAPHY
    SFA-occlusion right, moderately calcified

    PROCEDURAL STEPS
    1. Left groin access and cross-over approach
    - 5F IMA-cathter (CARDINAL HEALTH)
    - 0.035" soft angled glidewire 180 cm (TERUMO)
    - 0.035" SupraCore Guidewire 180 cm (ABBOTT)
    - 6F 40 cm Balkin Up&Over Sheath (COOK)

    2. Guidewire passage
    - 0.018" Connect guidewire, 300 cm (ABBOTT)
    - 4.0/120 mm Pacific Extreme balloon catheter, 135 cm (MEDTRONIC)
    - In case of thrombus Rotarex thrombectomy before PTA (STRAUB MEDICAL)

    3. PTA with drug-coated balloons
    - 5.0/120 mm In.Pact Pacific (MEDTRONIC)

    4. Stenting on indication
    - Complete selfexpanding nitinol-stent (MEDTRONIC)
    View image
  • Thursday, April 7th: - , Main Arena

    Case 03 – Chronic total occlusion SFA bilateral

    Center:
    University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
    Case 03 – LEI 03: male, 64 years (W-S)
    Operators:
    • Andrej Schmidt,
    • Yvonne Bausback
    CLINICAL DATA
    Severe claudication both calves, walking capacity 150 meters; right > left
    Rutherford classification 3
    Mitral insufficiency II, NYHA II
    Art. hypertension, former smoker
    COPD
    ABI right 0.66; left 0.67

    PROCEDURAL STEPS
    1. Left groin access and cross-over approach
    - 5F IMA-cathter (CARDINAL HEALTH)
    - 0.035" soft angled glidewire 180 cm (TERUMO)
    - 0.035" SupraCore guidewire 180 cm (ABBOTT)
    - 6F 40 cm Balkin Up&Over Sheath (COOK)

    2. Gudewire passage
    - 0.035" stiff angled glidewire, 260 cm (TERUMO)
    - Seeker support catheter, 135 cm (BARD)
    - Exchange to a 0.018" SteelCore guidewire, 300 cm (ABBOTT)

    3. PTA
    - VascuTrak balloon 5.0/250 mm (BARD)
    - Lutonix DCB 5.0 or 6.0/150 mm (BARD)

    4. Stenting on indication
    - LifeStent selfexpanding nitinol-stent (BARD)
    View image
  • Thursday, April 7th: - , Main Arena

    Case 05 – LEI 04: Reocclusion right SFA

    Center:
    University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
    Case 05 – LEI 04: female, 63 years (S-G)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    Severe claudication right SFA, walking capacity 100 meters
    PTA left SFA 2/2016
    PTA right SFA 2014 elsewhere
    CEA right internal carotid artery 2012
    Art. hypertension
    Diabetes mellitus type 2

    ANGIOGRAPHY
    Right SFA during PTA left SFA 2/2016
    ABI right 0.65

    PROCEDURAL STEPS
    1. Left groin access and cross-over approach
    - 5F IMA cathter (CARDINAL HEALTH)
    - 0.035" soft angled glidewire 180 cm (TERUMO)
    - 0.035" SupraCore guidewire 300 cm (ABBOTT)
    - 6F 40 cm Balkin Up&Over Sheath (COOK)

    2. Gudewire passage
    - 0.035" stiff angled glidewire, 260 cm (TERUMO)
    - CXC support catheter, 135 cm (COOK)
    - Exchange to a 0.035" SupraCore guidewire, 300 cm (ABBOTT)

    3. PTA and stenting
    - Advance 0.035" balloon 5.0/100 mm (COOK)
    - Zilver-PTX stents 6.0/120 mm (COOK)
    View image
  • Thursday, April 7th: - , Main Arena

    Case 06 – LEI 05: Re-occlusion left, partially in-stent

    Center:
    University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
    Case 06 – LEI 05: male, 58 years (G-N)
    Operators:
    • Andrej Schmidt,
    • Sven Bräunlich
    CLINICAL DATA
    Severe claudication left calf, walking capacity 100 meters, restpain during night
    Rutherford class 4
    Failed antegrade recanalization attempt left SFA 2/2016
    PTA and stenting left SFA elsewhere 1/2015
    CAD, COPD, art. hypertension, former smoker
    ABI left 0.55

    PROCEDURAL STEPS
    1. Right groin access and cross-over approach
    - 5F IMA-cathter (CARDINAL HEALTH)
    - 0.035" soft angled glidewire 180 cm (TERUMO)
    - 0.035" SupraCore guidewire 180 cm (ABBOTT)
    - 7F 40 cm Balkin Up&Over Sheath (COOK)

    2. Guidewire passage
    - 0.035" stiff angled glidewire, 260 cm (TERUMO)
    - QuickCross support catheter, 135 cm (SPECTRANETICS)
    - Exchange to a 0.014" Floppy ES Extrasupport guidewire, 300 cm (ABBOTT)

    3. In case of failure to pass the guidewire from antegrade
    Stent-puncture (proximal or disal stent):
    - 18 gauge 7 cm needle proximal and 21 gauge 9 cm needle distally (COOK)
    - 0.018" V-18 Control guidewire 300 cm (BOSTON SCIENTIFIC)
    - 0.018" QuickCross support catheter 90 cm (SPECTRANETICS)

    4. Laser atherectomy and PTA
    - 7F Tandem Booster-Laser atherectomy (SPECTRANETICS)
    - Stellarex DCB 5.0/120 mm (SPECTRANTICS)
    View image
  • Thursday, April 7th: - , Main Arena

    Case 08 – LEI 06: Severely calcified popliteal occlusion right

    Center:
    University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
    Case 08 – LEI 06: male, 62 years (KH-L)
    Operators:
    • Sven Bräunlich,
    • Andrej Schmidt
    CLINICAL DATA
    Critical limb ischemia with ulceration dig V
    Rutherford class 5
    CAD, ischemic cardiomyopathy, EF 45%, NYHA II
    Diabetes mellitus type 2, former smoker

    ANGIOGRAPHY
    Distal SFA / Apop P1-segment occlusion right
    Anterior and posterior tibial artery occlusion
    Severe calcification
    ABI right 0.33

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

    2. Guidewire passage
    - 0.035" stiff angled glidewire, 260 cm (TERUMO)
    supported by a balloon:
    - Armada 35 balloon 4.0/80 mm, 90 cm (ABBOTT)
    in case of failure to pass the CTO from antegrade retrograde approach via peroneal artery:
    - 7 cm 21 gauge needle (COOK)
    - 0.018" Connect guidewire 300 cm (ABBOTT)
    - 0.018" QuickCross support catheter (SPECTRANETICS)

    3. PTA and stenting
    - Armada 5.0 or 6.0/40 mm (ABBOTT)
    - 5.0 Supera Interwoven nitinol-stent (ABBOTT)
    View image
  • Thursday, April 7th: - , Main Arena

    Case 09 – LEI 07: Anterior tibial artery occlusion, multiple ulcerations forefoot left

    Center:
    University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
    Case 09 – LEI 07: male, 65 years (H-G)
    Operators:
    • Matthias Ulrich,
    • Yvonne Bausback
    CLINICAL DATA
    Ulceration Left foot, Rutherford class 5
    Failed antegrade recanalization attempt with failure to pass the guidewire through the ATA-CTO elsewhere
    Diabetes mellitus type 2, art. hypertension, former smoker

    ANGIO
    ABI right 0.44
    Anterior tibial artery occlusion left, high offspring

    PROCEDURAL STEPS
    1. Antegrade access left
    - 6F 55 cm sheath (COOK)

    2. Retrograde approach via the dorsalis pedis artery left
    - Pedal puncture set (COOK)
    - 4 cm 21 gauge needle (COOK)
    - 2.9F sheath (COOK)
    - 0.018" V-18 Control guidewire 300 cm (BOSTON SCIENTIFIC)
    - 0.018" CXI support catheter 90 cm (COOK)
    - Exchange to 0.014" Hydro-ST guidewire 300 cm (COOK)
    - Advance Micro balloon 3.0/120 mm, 90 cm (COOK)

    3. PTA from antegrade with DCBs
    After predilatation from retrograde
    - Lutonix DCBs from antegrade (BARD)
    View image
  • Thursday, April 7th: - , Main Arena

    Case 10 – LEI 08: Progressive, highgrade stenosis left internal carotid artery

    Center:
    University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
    Case 10 – LEI 08: male, 72 years (R-F)
    Operators:
    • Andrej Schmidt,
    • Sven Bräunlich
    CLINICAL DATA
    90% stenosis left ICA
    Minor stroke 1/2015
    Art. hypertension, diabetes mellitus type 2
    CAD with NSTEMI 11/2015, PTCA

    RISK FACTORS
    Left ICA flow-velocity progression
    1/2015: 2.5m/sec
    11/2015: 4.8m/sec
    Angiography during PTCA 11/2015: 90% stenosis left ICA

    PROCEDURAL STEPS
    1. Right groin access
    - 9F 25 cm sheath (TERUMO)

    2. Cannulation of the left external carotid artery
    - 5F Judkins right diagnostic catheter (CARDINAL HEALTH)
    - 0.035" soft angled glidewire, 190 cm (TERUMO)
    - Exchange to 0.035" SupraCore guidewire, 190 cm (ABBOTT)

    3. Cerebral protection
    - MOMA endovascular clamping device (MEDTRONIC)

    4. Predilatation, stenting and postdilatation
    - 3.5/20 mm MiniTrek RX balloon (ABBOTT)
    - Roadsaver carotid artery stent system (TERUMO)
    - 5.0/20 mm Sterling RX balloon (BOSTON SCIENTIFIC)

    5. Aspiration of potential plaque-debris before declamping of the MOMA-system

    6. Final angiography
    View image
  • Friday, April 8th: - , Main Arena

    Case 11 – LEI 09: Severely calcified distal SFA / Apop-CTO right

    Center:
    University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
    Case 11 – LEI 09: male, 59 years (P-R)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    Restpain right foot, walking capacity 50 meters, claudication right calf
    Rutherford class 4
    PTA and stenting iliac arteries 2012 and 2/2016
    Failure to recanalize the SFA / Apop-occlusion right from antegrade
    TEA right groin 2014, PTA / Supera-stent left popliteal artery 3/2015
    End stage renal failure with chronic dialysis
    CAD, PTCA 2012, ICD

    RISK FACTORS
    ABI: > 1.4 (mediasclerosis)
    Severely calcified total occlusion of the distal SFA and Apop right

    PROCEDURAL STEPS
    1. Right groin antegrade access
    - 7F 40 cm Balkin Up&Over Sheath (COOK)

    2. Second attempt to pass the CTO from antegrade
    - 0.035" stiff angled glidewire, 260 cm (TERUMO)
    - 4.0/80 mm Armada 35 balloon, 90 cm (ABBOTT)

    3. In case of failure retrograde approach via the proximal anterior tibial artery
    - 7 cm 21 gauge needle (COOK)
    - 0.018" Connect guidewire, 300 cm (ABBOTT)
    - 0.018" CXC support catheter, 90 cm (SPECTRANETICS)
    potentially sheath-insertion:
    - 4F 10 cm Radiofocus Sheath, 0.025" GW-compatible (TERUMO)

    4. PTA and stenting
    - 5.0/40 mm and 6.0/40 mm Armada 35 balloon (ABBOTT)
    - 5.0 or 6.0 mm Supera interwoven nitinol-stent (ABBOTT)
    View image
  • Friday, April 8th: - , Main Arena

    Case 13 – LEI 10: Percutaneous EVAR

    Center:
    University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
    Case 13 – LEI 10: male, 72 years (M-W)
    Operators:
    • Andrej Schmidt,
    • Daniela Branzan
    CLINICAL DATA
    Progressive infrarenal abdominal aortic aneurysm
    Art. hypertension, former smoker
    Prostatic cancer surgery 2015

    DUPLEX
    Duplex-sonographic measurement
    12/2012: 32 mm max. diameter
    12/2015: 51 mm max. diameter, excentric infrarenal aneurysm


    PROCEDURAL STEPS
    1. Percutaneous access in local anaesthesia both groins
    - Preloading of 2 Proglide-systems per groin (ABBOTT)
    - 9F 10 cm Radiofocus sheath (TERUMO)
    - Lunderquist guidewire 180 cm (COOK)

    2. Implantation of the stentgraft
    - Ovation stentgraft (ENDOLOGIX / TRIVASCULAR)
    - Polymere filling of the graft
    - Cannulation of the contralateral limb
    - 5F Amplatz left diagnostic catheter (CARDINAL HEALTH)
    - 0.035" soft angled guidewire, 190 cm (TERUMO)
    - Implantation of both limb-extensions (ENDOLOGIX / TRIVASCULAR)

    3. PTA
    - Proximal seal: Reliant balloon (MEDTRONIC)
    - Graft-bifurcation: 12/40 mm Admiral balloon in kissing-technique (MEDTRONIC)

    4. Closure of the groins
    - Preloaded Proglide-systems (ABBOTT)
    View image
  • Friday, April 8th: - , Main Arena

    Case 14 – LEI 11: Iliofemoral venous intervention

    Center:
    University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
    Case 14 – LEI 11: female, 28 years (L-M)
    Operators:
    • Andrej Schmidt,
    • Yvonne Bausback,
    • Daniela Branzan
    CLINICAL DATA
    Iliac vein left side and distal inferior vena cava thrombosis 6/2013
    Venous claudication left (painfree walking capacity 500 meters)
    Swelling left leg despite compression therapy
    No skin changes, groin varicosis left

    PRESENT STATE
    Phlebography via popliteal vein:
    postthrombotic residuum left common femoral vein,
    total occlusion iliac vein left, varicous groin-veins.

    PROCEDURAL STEPS
    1. Prone position of the patient in general anaesthesia

    2. Duplex-guided access left popliteal vein
    - 11F 10 cm Radiofocus sheath (TERUMO)

    3. Guidewire passage of the left iliac veins
    - 0.035" stiff straight glidewire, 260 cm (TERUMO)
    - 4F 100 cm Judkins Right diagnostic catheter (CARDINAL HEALTH) or
    - 0.018" V-18 Control guidewire, 300 cm (BOSTON SCIENTIFIC)
    - 3.0/120 mm Pacific Extreme balloon (MEDTRONIC)

    4. PTA
    - Atlas high pressure balloon 14/60 mm (BARD)

    5. Implantation of dedicated iliac vein stents
    - Sinus-Obliquus 14-16 mm (OPTIMED)
    - Sinus-XL Flex 14-16 mm (OPTIMED) or
    - Zilver Vena venous self-expanding stent (COOK)

    6. Postdilatation
    - Atlas high pressure balloon 14/60 mm (BARD)
    View image
  • Friday, April 8th: - , Main Arena

    Case 15 – LEI 12: Acute reocclusion left SFA after PTA / stent

    Center:
    University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
    Case 15 – LEI 12: male, 62 years (S-D)
    Operators:
    • Sven Bräunlich,
    • Matthias Ulrich
    CLINICAL DATA
    Severe claudication left calf, walking capacity 150 meters
    Rutherford class 3
    PTA left SFA 1/2016 elsewhere with an acute reocclusion 2 days post PTA
    CAD, MI 2012
    Diabetes mellitus type 2, art. hypertension, current smoker

    CURRENT STATE
    ABI left 0.70
    Angiography of the left SFA-stenosis before PTA and after stenting
    Angiography of the acute reocclusion of the SFA 2 days later

    PROCEDURAL STEPS
    1. Right groin retrograde and cross-over approach
    - IMA diagnostic 5F catheter (CORDIS / CARDINAL HEALTH)
    - 0.035" angled soft Radiofocus glidewire, 190 cm (TERUMO)
    - 0.035" SupraCore guidewire, 190 cm (ABBOOTT)
    - 8Fr Balkin Up&Over Sheath, 40 cm (COOK)

    2. Passage of the occlusion and percutaneous thrombectomy
    - 0.018" Connect guidewire 300 cm (ABBOTT)
    - 0.018" QuickCross support catheter 135 cm (SPECTRANETICS)
    - Exchange to Rotarex guidewire (STRAUB MEDICAL)
    - 8F Rotarex thrombectomy catheter (STRAUB MEDICAL)

    3. PTA with DCBs
    - In.Pact Pacific 5.0/120 mm (MEDTRONIC)

    4. Stenting on indication
    - Complete selfexpanding nitinol-stent (MEDTRONIC)
    View image
  • Friday, April 8th: - , Main Arena

    Case 16 – LEI 13: Restpain left leg, unsuccessful recanalization attempt

    Center:
    University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
    Case 16 – LEI 13: male, 76 years (M-P)
    Operators:
    • Matthias Ulrich,
    • Andrej Schmidt
    CLINICAL DATA
    Restpain left foot, claudication left calf, walking capacity 20 meters
    Rutherford class 4
    Fem-pop bypass surgery left 2012 with early failure
    PTA and stent left distal SFA 1/2013
    Reocclusion 12/2015 and failure to recanalize from antegrade and retrograde elsewhere
    Art. hypertension
    Surgery of a colon-carcinoma 2012

    ANGIOGRAPHY
    Left: total occlusion of the SFA to the popliteal segment
    ABI left 0.2

    PROCEDURAL STEPS
    1. Right groin retrograde and cross-over approach
    - IMA diagnostic 5F catheter (CORDIS / CARDINAL HEALTH)
    - 0.035" angled soft Radiofocus glidewire, 190 cm (TERUMO)
    - 0.035" SupraCore guidewire, 190 cm (ABBOOTT)
    - 6F Balkin Up&Over Sheath, 40 cm (COOK)

    2. Retrograde approach via the occluded SFA
    - 18 gauge 7 cm needle (COOK)
    - 0.035" stiff angled glidewire 190 cm (TERUMO)
    - 4F 12 cm Sheath (St. JUDE)
    - 0.018" Connect 250 T guidewire, 300 cm (ABBOTT)
    - 4F Judkins right diagnostic catheter (CARDINAL HEALTH)

    3. In case of failure to reenter from retrograde into the common femoral artery
    - Exchange to a 6F 10 cm sheath (TERUMO)
    - Outback reentry device from retrograde (CARDINAL HEALTH)
    - 0.014 Stabilizer 300 cm guidewire (CARDINAL HEALTH)

    4. PTA and stenting
    - Advance 18 balloon 5.0/100 mm (COOK)
    - Zilver-PTX stent (COOK)
    View image
  • Friday, April 8th: - , Main Arena

    Case 18 – LEI 14: Restpain with popliteal occlusion left

    Center:
    University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
    Case 18 – LEI 14: male, 56 years (J-H)
    Operators:
    • Sven Bräunlich,
    • Matthias Ulrich
    CLINICAL DATA
    Restpain left foot, claudication left calf, walking capacity 20 meters
    Rutherford class 4
    Failure to recanalize from antegrade elsewhere Art. Hypertension

    ANGIOGRAPHY
    Chronic occlusion of the left popliteal artery (P1-P3)
    ABI left: 0.4

    PROCEDURAL STEPS
    1. Left antegrade approach
    - 6F 55 cm sheath (COOK)

    2. Second attempt to pass the occlusion from antegrade
    - Connect 250 T guidewire, 300 cm (ABBOTT)
    - 4.0/80 mm Pacific Extreme balloon, 90 cm (MEDTRONIC)

    3. In case of failure: retrograde approach via the proximal anterior tibial artery
    - 7 cm 21 gauge needle (COOK)
    - Connect guidewire, 300 cm (ABBOTT)
    - QuickCross support catheter (SPECTRANETICS)

    4. PTA and stenting
    - 5.0 and 6.0/40 mm Pacific Extreme balloon (MEDTRONIC)
    - 5.0 and 6.0 Supera interwoven nitinol stent (ABBOTT)
    View image
  • Friday, April 8th: - , Main Arena

    Case 19 – LEI 15: Restpain with multilevel disease right

    Center:
    University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
    Case 19 – LEI 15: female, 82 years (H-L)
    Operators:
    • Andrej Schmidt,
    • Yvonne Bausback
    CLINICAL DATA
    Restpain right foot, claudication left calf, walking capacity 50 meters
    Rutherford class 4
    Art. Hypertension

    ANGIOGRAPHY
    Right: Proximal SFA-stenosis, occlusion of the P1-segment and tibioperoneal trunk
    ABI left: 0.44

    PROCEDURAL STEPS
    1. Left groin retrograde and cross-over approach
    - IMA diagnostic 5F catheter (CARDINAL HEALTH)
    - 0.035" angled soft Radiofocus glidewire, 190 cm (TERUMO)
    - 0.035" SupraCore guidewire, 190 cm (ABBOOTT)
    - 7F Balkin Up&Over Sheath, 40 cm (COOK)

    2. Guidewire passage
    - Connect 250 T guidewire, 300 cm (ABBOTT)
    - CXC support catheter, 135 cm (COOK)

    3. Filter protection and atherectomy
    - Spider-filter 4 mm into the posterior tibial artery (MEDTRONIC)
    - HawkOne 6.6 cm tip (MEDTRONIC)

    4. PTA with drug-coated balloons
    - In.Pact Pacific 5.0 and 4.0 mm (MEDTRONIC)
    View image
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