LINC Asia-Pacific 2015 live case guide

Find all live cases and live case centers listed below.

Conference day 3

  • - , Main Arena

    Case 21 – Infra-renal abdominal aortic aneurysm

    Center:
    Beijing Military Hospital 301, Beijing, China
    Case 21 – BMH 02: male, 75 years
    Operators:
    • Wei Guo,
    • Xin Jia
    CLINICAL DATA
    Documented abdominal aortic aneurysm in May 2012
    Coronary artery disease
    Hypertension

    ANGIOGRAPHY
    CT angiography of abdominal aorta shows:
    Maximum aneurysm diameter 60/57 mm, short and angulated neck
    Right iliac: CIA 18 mm, EIA 9 mm
    Left iliac: CIA 14 mm, EIA 11 mm

    PROCEDURAL STEPS
    1. Bilateral percutanous femoral artery access
    - Perclose preloaded (ABBOTT)

    2. Left brachial artery access for provisional chimney stent
    - 6F 90 cm Flexor long sheath (COOK)
    - Chimney stent in left renal artery: Genesis 6-18 (CORDIS)

    3. Stent graft
    - ENDURANT (MEDTRONIC)
    - Main body from left access: 28-16-170 mm
    - Right leg: 16-20-120 mm
    View image
  • - , Main Arena

    Case 22 – Infra renal AAA 6.6 cm with right CIA anuerysm

    Center:
    Singapore General Hospital, Singapore
    Case 22 – SGH 01: male, 80 years (A-A-R)
    Operators:
    • Kiang Hiong Tay,
    • John Wang,
    • Ankur Patel,
    • Jack Ch‘ng
    CLINICAL DATA
    Incidentally detected infra-renal abdominal aortic anuerysm (6.5 x 6.5 cm)
    extending into the right common iliac artery
    Clinical examination: Expansile pulsatile mass in abdomen

    RISK FACTORS
    Hypertension, hyperlipiedemia
    Mild Alzheimer dementia

    CT AORTOGRAM
    6.5 cm infra-renal AAA with anyersmal right CIA (2.7 cm)

    PLAN
    pEVAR with right iliac branch device

    PROCEDURAL STEPS
    1. US guided percutaneous access of both CFAs followed by preclosing with 2 Proglide closure devices.

    2. Aortogram and placement of Lunderquist wire from right side.

    3. Insertion of Zenith iliac branch device (COOK MEDICAL) from right side.
    Snaring of the through and through wire using Indi snare (COOK MEDICAL) from the left side. Insertion of 7F long sheath into the branch from left side. Selective cannulation of the right internal iliac artery and placement of stiff wire (ROSEN).
    Insertion of Atrium covered stent into the right IIA.

    4. Placement of stiff wire (Lunderquist) from left side.
    Insertion of the COOK Zenith stent graft main body from the left side.

    5. Cannulation of the contra-lateral limb from the right side and placement of bridging piece.

    6. Completion of deployment of main body and extension of left ipsilateral limb.

    7. Closure with preclose Proglide.
    View image
  • - , Main Arena

    Case 23 – Occlusion of left superficial femoral artery

    Center:
    Beijing Military Hospital 301, Beijing, China
    Case 23 – BMH 03: male, 65 years
    Operators:
    • Wei Guo,
    • Xin Jia
    CLINICAL DATA
    PAOD Rutherford 3
    Intermittent claudication of left leg
    Diabetes mellitus for 20 years
    ABI left 0.45, right 0.72

    PROCEDURAL STEPS
    1. Retrograde access of right groin
    - 0.035" Radiofocus Terumo angled soft guidewire, 180 cm (TERUMO)
    - 6F Flexor straight sheath, 50 cm (COOK)

    2. Passage of the lesion
    - 0.018" V-18 control wire, 300 cm (BOSTON SCIENTIFIC)
    - 4/120 mm Pacific dilatation catheter, 120 cm (MEDTRONIC)

    3. Dilatation and provisional stent
    - 4/120 mm Pacific dilatation catheter,120 cm (MEDTRONIC)
    - 6/150 mm Complete SE Nitinol vascular stent, 120 cm (MEDTRONIC)

    4. Retrograde SFA puncture in case of antegrade failure
    - 0.018" V-18 control wire, 300 cm (BOSTON SCIENTIFIC)
    - 4/120 mm Pacific dilatation catheter, 120 cm (MEDTRONIC)
    View image
  • - , Main Arena

    Case 24 – Right SFA chronic total occlusion

    Center:
    Singapore General Hospital, Singapore
    Case 24 – SGH 02: male, 70 years (T-C-H)
    Operators:
    • Farah Gillan Irani,
    • John Wang,
    • Ankur Patel
    CLINICAL DATA
    Right lateral foot wound, started as an abrasion and gotten progressively worse
    Left BKA

    RISK FACTORS
    Poorly controlled diabetes mellitus
    Chronic hyponatreamia

    DOPPLER STUDY
    Long segment SFA occlusion with stenosis in the popliteal artery and ATA occlusion

    ANGIOGRAM
    Long segment calcified SFA occlusion

    PROCEDURAL STEPS
    1. Antegrade right CFA access with US guidance and insertion of 6F Brite tip sheath (CORDIS)

    2. Antegrade recannalisation of SFA
    - 4F Bernstein and 0.035" stiff terumo/ 0.018" V18
    - 2.7F COOK CXI with 0.014" Winn 200T wire (ABBOTT)

    3. If antegrade approach fails for retrograde access via popliteal artery and SAFARI
    - 0.018" V18 and 2.7F Cook CXI catheter

    4. Following crossing angioplasty with DEB +/- stent

    5. Internal balloon tamponade of popliteal access site

    6. Attempts at recannalisation of the ATA

    7. Closure
    - 6F StarClose closure device (ABBOTT)
    View image
  • - , Main Arena

    Case 25 – Severely calcified SFA-occlusion left

    Center:
    University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
    Case 25 – LEI 08: male, 72 years (G-W)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    CLI with toe-ulceration left since 1 month
    Severe claudication left calf
    CAD, PTCA 1998
    Chronic renal insufficiency, GFR 56 ml/ min

    ANGIOGRAPHY
    During PTA of an iliac stenosis left:
    Long, highly calcified SFA-occlusion left

    PROCEDURAL STEPS
    1. Right groin access and cross-over approach
    - 7F 40 cm Cross-over Balkin Up&Over sheath (COOK)

    2. Passage of the occlusion left SFA
    - 0.035" stiff angled glidewire, 260 cm
    - CXC 0.035" support catheter 135 cm (COOK)

    3. PTA
    - Armada 5/120 mm balloon (ABBOTT)

    In case of residual stenosis focal high-pressure PTA:
    - Conquest 6/20 mm non-compliant balloon (BARD)

    4. Stenting
    - Supera interwoven nitinol stents (ABBOTT)
    View image
  • - , Main Arena

    Case 26 – Chronic total occlusion left SFA

    Center:
    Singapore General Hospital, Singapore
    Case 26 – SGH 03: female, 75 years (N-H-T)
    Operators:
    • Kiang Hiong Tay,
    • Farah Gillan Irani
    CLINICAL DATA
    PAOD with non healing ulcer on lateral aspect of left first toe with sloughy base
    Non palpable left DP/PT /Popliteal

    RISK FACTORS
    Smoker
    Hypertension
    Hyperlipidemia

    DOPPLER STUDY
    Left leg: Chronic total occlusion of left SFA with stenosis
    in the popliteal artery and with long segment ATA occlusion
    Left Toe pressure 60

    PROCEDURAL STEPS
    1. US guided antegrade approach
    - 6F 11 cm Brite tip sheath (CORDIS)

    2. Antegrade crossing of SFA CTO
    - 4F Bernstein catheter and 0.035" stiff terumo (TERUMO)
    - 0.018" V18 wire (BOSTON SCIENTIFIC)
    - If fails then, retrograde approach via proximal ATA puncture using micropuncture set (COOK) and SAFARI technique 2.7F CXI catheter (COOK) and 0.018" V18 wire (BOSTON SCIENTIFIC)

    3. Angioplasty
    - MUSTANG balloon (BOSTON SCIENTIFIC)

    4. Stenting
    - SUPERA stent (ABBOTT)

    5. Proximal ATA access site controlled using internal balloon tamponade
    - 3 mm STERLING balloon (BOSTON SCIENTIFIC)

    6. ATA occlusion recannalisation
    0.018" V18 wire (BOSTON SCIENTIFIC) followed by plasty with 3 mm Sterling balloon

    7. Closure
    - 6F StarClose closure device (ABBOTT) using fluoroscopic and US guidance
    View image
  • - , Main Arena

    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)
    View image
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