University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
10 livecase(s)
Monday, March 9th:
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,
Main Arena
Case 05 – High grade progressive stenosis right ICA
Center:
University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
Case 05 – LEI 01: female, 60 years (C-K)
Operators:
Andrej Schmidt,
Matthias Ulrich
CLINICAL DATA
Progressive, asymptomatic stenosis right ICA
PAOD, claudication both calfs
RISK FACTORS
Art. hypertension
Diabetes mellitus
Former smoker
DUPLEX
3.8m/sec.
Cranial CT without pathological findings
ANGIOGRAPHY
Calcified, 80% stenosis right ICA
PROCEDURAL STEPS 1. 9F-sheath right groin
- 9F 25 cm (TERUMO)
2. Cannulation of the external carotid artery right
- 5F diagnostic Right Judkins catheter (CORDIS)
- 0.035" angled soft glidewire (TERUMO)
3. Exchange to a stiff guidewire and positioning of the protection device
- 0.035" SupraCore 300 cm (ABBOTT)
- 9F MOMA-system (MEDTRONIC)
- Endovascular clamping of the external and common carotid artery
4. Cannulation of the stenosis and predilatation
- 0.014" Galeo Pro ES, 175 cm (BIOTRONIK)
- 3.5/20 mm MiniTrek RX-balloon (ABBOTT)
5. Implantation of a stent and postdilatation
- Cristallo Ideale 7-10/30 mm (MEDTRONIC)
- 5.0/20 mm Submarine Rapido balloon (MEDTRONIC)
University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
Case 08 – LEI 03: male, 62 years (W-T)
Operators:
Matthias Ulrich,
Andrej Schmidt
CLINICAL DATA
Severe bilateral claudication intermittens
Walking capacity 150 meters
Failed recanalization attempt right SFA Feb. 2015
CAD, PTCA 2012
RISK FACTORS
Diabetes mellitus type 2
Art. hypertension
Former smoker
ANGIOGRAPHY
bilateral long SFA-occlusions
ABI
Right 0.54; left 0.60
PROCEDURAL STEPS 1. Access left groin and cross-over access
- 5F IMA-catheter (CORDIS)
- 0.035" SupraCore guidewire 200 cm (ABBOTT)
- 6F 40 cm Balkin Up&Over sheath (COOK)
2. Passage of the occlusion
Second antegrade attempt:
- 0.035" CXI Support-Catheter 135 cm (COOK)
- 0.035" stiff angled glidewire, 300 cm (TERUMO)
In case of failure to pass from antegrade: 3. Retrograde puncture of the distal SFA
- 21 Gauge 9 cm puncture-needle (COOK)
- 0.018" V-18 Control guidewire 300 cm (BOSTON SCIENTIFIC)
- 0.018" CXI support catheter 90 cm (COOK)
- Snaring of the retrograde guidewire from above
University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
Case 09 – LEI 04: female, 78 years (T-T)
Operators:
Andrej Schmidt,
Johannes Schuster
CLINICAL DATA
Restpain left foot, Rutherford class 4
PTA / stent left SFA 2011,
PTA of a restenosis left SFA Feb 2015,
Failure to recanalize the ATA from antegrade Feb 2015
CAD with CABG and PTCA 1999
RISK FACTORS
Diabetes mellitus type 2
Art. hypertension
ABI
Left 0.4
PROCEDURAL STEPS 1. Antegrade access left groin
- 5F 55 cm Ansel sheath (COOK)
2. Retrograde approach via the distal ATA
- Micro-puncture set (COOK)
. - 3F micropuncture sheath
. - 4 cm 21 Gauge needle
- 0.018" Connect guidewire 300 cm (ABBOTT)
3. Retrograde guidewire passage and PTA
- 0.014" Hydro-ST guidewire 300 cm (COOK)
- 2.5/120 mm Advance Micro balloon, 90 cm (COOK)
Case 10 – Total occlusion all BTK-arteries right, CLI
Center:
University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
Case 10 – LEI 05: male, 71 years (D-F)
Operators:
Andrej Schmidt,
Matthias Ulrich
CLINICAL DATA
Restpain right foot,
Bypass fem-pop nd PTA iliac arteries right 1/2014
Failed recanalization attempt BTK right Feb 2015
Chronic venous insufficiency
RISK FACTORS
Diabetes mellitus type 2
Art. hypertension
ANGIOGRAPHY
During recanalization attempt right Feb. 2015:
Bypass patent, all 3 BTK-arteries occluded
PROCEDURAL STEPS 1. Antegrade access right
- 5F 55 cm Ansel-sheath (COOK)
2. Retrograde access via the distal peroneal artery
- 7 cm 21 Gauge needle (COOK)
- 0.018" Connect guidewire 300 cm (ABBOTT)
- 0.018" Seeker-support catheter 90 cm (BARD)
3. Snaring of the retrograde guidewire from antegrade and antegrade PTA
- 2.0 120 mm Pacific balloon (MEDRONIC)
- 3.0/150 Lutonix DCB (BARD)
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)
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)
Case 27 – CLI right with occlusion of the TPT and ATA
Center:
University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
Case 27 – LEI 09: male, 73 years (H-G-T)
Operators:
Matthias Ulrich,
Andrej Schmidt
CLINICAL DATA
CLI with minor gangrene Dig 2 and rest-pain
Failed antegrade recanalization attempt right Feb 2015
CAD with PTC 2007
Atrial fibrillation
ANGIOGRAPHY
Occlusion right TPT and ATA
ABI
Right 0.32
PROCEDURAL STEPS 1. Right antegrade access
- 6F 55 cm Ansel-sheath (COOK)
2. Retrograde passage of the ATA
ADp-puncture with:
- 3F micropuncture set (COOK)
- 4 cm 21 Gauge needle (COOK)
- 3F sheath (COOK)
- 0.018" Connect 300 cm guidewire (ABBOTT)
3. Passage of the lesion
- 0.014" Hydro-ST Guidewire 300 cm (COOK)
- Advance Micro balloon 2.5/120 mm from retrograde (COOK)
- Potentially PTA of the TPT and ATA bifurcation in kissing-technique from above and below
- Xience Prime Everolimus-eluting stent (ABBOTT)
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