LINC Asia-Pacific 2015 live case guide

Chang Gung Memorial Hospital, Taoyuan City, Taiwan

• Monday, March 9th: 9:05 - 9:30, Main Arena

  Case 02 – DEB for SFA/PopA stenosis

  Center:

  Chang Gung Memorial Hospital, Taoyuan City, Taiwan

  Case 02 – TAO 01: female, 80 years (H-M-L)

  Operators:

  • I-Hao Su,
  • Sung-Yu Chu

  CLINICAL DATA
  Rutherford 5, chronic minor wound at left big toe
  DM type 2, HTN, hepatitis C
  Bilateral PAD s/p right femoral-popliteal graft bypass
  s/p left knee replacement
  EF: 76%, Cr 0.79
  
  CTA
  Skipped focal mild-severe stenosis in the LSFA
  Focal skipped mild stenosis in the P3 portion of LPopA
  Short CTO in the proximal LATA
  and skipped focal high grade stenosis
  
  DUPLEX
  ABI: right 0.57, left 0.55
  Lt. distal CFA bifurcation mod stenosis; 
and lt. femoropopliteal difuse stenosis 
and multiple significant lesions; 
bil severe infrapopliteal diseased 
with multiple severe stenosis 
and segemental occcluded lesions at bil ATA amd PTA
  
  PROCEDURAL STEPS
  1. Retrograde access (ultrasound guided puncture) via RCFA
  - 5F Tempo Flush pigtail catheter (CORDIS)
  - 0.035" Radiofocus Terumo Angled Stiff guidewire (TERUMO)
  - 6F Balkin cross over sheath (COOK)
  
  2. Passage of the lesion with hydrophilic wire to TP
  - 0.018" V18 control wire, 300 cm (BOSTON SCIENTIFIC)
  
  3. Predilatation and PTA with DEB for SFA/PopA
  - Pacific Xtreme 4/40 (MEDTRONIC)
  - In-Pact Pacific DEB balloon 5/6 mm (MEDTRONIC)
  
  4. PTA for BTK
  - 0.018" V18 control wire, 300 cm (BOSTON SCIENTIFIC)
  - Amphirion 2/2.5/3 (MEDTRONIC)

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• Monday, March 9th: 11:08 - 11:37, Main Arena

  Case 04 – DEB for ISR in hemodialysis access

  Center:

  Chang Gung Memorial Hospital, Taoyuan City, Taiwan

  Case 04 – TAO 02: male, 85 years (T-H-Y)

  Operators:

  • Ta-We Su,
  • Sung-Yu Chu

  CLINICAL DATA
  ESRD under regular hemodialysis, hearing impairment, EF 71%
  Left radio-graft-basilic fistula s/p Viabahn (6/150 mm)
  for venous anastomosis junction
  
  RISK FACTORS
  Increased venous pressure during hemodialysis
  
  VENOGRAPHY
  Two skipped focal instent stenosis (about 30-50% stenosis)
  and short segmental 70% stenosis in the distal edge of Viabahn
  
  PROCEDURAL STEPS
  1. Antegrade puncture via proximal graft
  - 6F sheath (TERUMO)
  
  2. Angiography to estimate lesions
  
  3. PTA with DEB for instent restenosis
  - InPact Admiral DEB balloon 6/120 mm (MEDTRONIC)

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• Tuesday, March 10th: 10:08 - 10:28, Main Arena

  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)
  
  2. Angiography of AAA
  - 5F Tempo Flush pigtail catheter (CORDIS)
  - 0.035" Radiofocus Terumo Angled soft guidewire (TERUMO)
  - 0.038" Amplatz Stiff wire, 260 cm (BOSTON SCIENTIFIC)
  - 5F sizing catheter (MERIT)
  
  3. Deployment of AAA stent graft
  - Endurant: mainbody left side up, contralateral limb: right side (METRONICS)
  - 5F VanSchie catheter (COOK)
  - 0.035" Radiofocus Terumo Angled soft guidewire (TERUMO)
  - 0.038" Amplatz Stiff wire, 260 cm (BOSTON SCIENTIFIC)
  
  4. Post dilatation
  
  5. Retrograde access (ultrasound guided puncture) via left brachial artery
  - 5F Tempo Flush pigtail catheter (CORDIS)
  - 0.035" Radiofocus Terumo Angled soft guidewire (TERUMO)
  
  6. Cannulation of RIIA
  - 5F Tempo Aqua Hydrophilic coating catheter (CORDIS)
  - 0.035" Radiofocus Terumo Angled soft guidewire (TERUMO)
  
  7. Distal sandwich technique: Deployment of stent graft for REIA and RIIA
  - Viabahn stent graft 10/100-150 mm (GORE)
  
  8. Postdilatation

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