LINC Asia-Pacific 2015 live case guide

Find all live cases and live case centers listed below.

Conference day 2

  • - , Main Arena

    Case 12 – Left ATA occlusion

    Center:
    Changi General Hospital, Singapore
    Case 12 – CGH 05: male, 58 years (K-S-O)
    Operators:
    • Steven Kum,
    • Tan Yih Kai,
    • Sven Bräunlich
    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)
    View image
  • - , Main Arena

    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)
    View image
  • - , 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
    View image
  • - , Main Arena

    Case 15 – Left SFA occlusion

    Center:
    Changi General Hospital, Singapore
    Case 15 – CGH 06: male, 75 years (M-L)
    Operators:
    • Sven Bräunlich,
    • Steven Kum,
    • Tan Yih Kai
    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)
    View image
  • - , Main Arena

    Case 16 – Left SFA in-stent occlusion

    Center:
    Changi General Hospital, Singapore
    Case 16 – CGH 07: male, 55 years (B-P-T)
    Operators:
    • Sven Bräunlich,
    • Tan Yih Kai,
    • Steven Kum,
    • Tjun Tang
    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)

    5. Postdebulking IVUS
    - 0.014" Eagle Eye® Platinum IVUS catheter with virtual histology

    6. Treatment with DEB and stenting on indication
    - In.Pact Pacific 5/6 x 120 mm DEB-balloon (MEDTRONIC)
    - SUPERA stent (ABBOTT)
    View image
  • - , Main Arena

    Case 17 – Chronic SFA-occlusion left

    Center:
    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)
    View image
  • - , Main Arena

    Case 18 – Right SFA/popliteal occlusion

    Center:
    Changi General Hospital, Singapore
    Case 18 – CGH 08: male, 70 years (A-H-T)
    Operators:
    • Steven Kum,
    • Tan Yih Kai,
    • Sven Bräunlich
    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
    View image
  • - , Main Arena

    Case 19 – Left popliteal stenosis

    Center:
    Changi General Hospital, Singapore
    Case 19 – CGH 09: female, 65 years (R)
    Operators:
    • Sven Bräunlich,
    • Steven Kum,
    • Tan Yih Kai
    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)

    5. Filter retrieval
    View image
  • - , Main Arena

    Case 20A – CLI minor gangrene forefoot left

    Center:
    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)

    5. Stenting
    - Supera Interwoven nitinol stent (ABBOTT)
    View image
  • - , Main Arena

    Case 20B – Multi-level lesion left (EIA, CFA and SFA-stenosis)

    Center:
    University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
    Case 20B – LEI 07B: male, 49 years (S-P)
    Operators:
    • Andrej Schmidt,
    • Sabine Steiner
    CLINICAL DATA
    Severe claudication left, walking capacity 50 meters
    ABI left 0.4
    CAD with PTCA 2014

    RISK FACTORS
    Smoker
    Art. hypertension

    ANGIOGRAPHY
    Small external iliac artey left, high-grade stenosis left CFA, 
SFA diffusely diseased

    PROCEDURAL STEPS
    1. Access right groin and cross-over approach to left
    - 5F IMA diagnistic catheter (CORDIS)
    - 8F 40 cm Balkin Up&Over sheath (COOK)

    2. Directional atherectomy of the CFA left
    - Spider-Filter 6 mm distal SFA (COVIDIEN/MEDTRONIC)
    - TurboHawk LX-C (COVIDIEN/MEDTRONIC)

    3. PTA of the CFA and SFA
    - In.Pact Pacific 6 mm and 5 mm (MEDTRONIC)
    View image
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