LINC Asia-Pacific 2016 live case guide

Find all live cases and live case centers listed below.

Conference day 1

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    Case 01 – NY 01: Chronic total occlusion RSFA (TASC D)

    Center:
    Mount Sinai Hospital, New York, USA
    Case 01 – NY 01: male, 71 years, (C-T)
    Operators:
    • Prakash Krishnan,
    • Karthik Gujja,
    • Vishal Kapur
    R leg claudication, Rutherford class II, category III, Fontaine IIB
    US duplex showed occlusion of RSFA

    RISK FACTORS
    Hypertension, diabetes mellitus II, dyslipidemia, ex smoker, PAD

    PROCEDURAL STEPS
    1. Left common femoral access and up and over
    - 7F Pinnacle destination sheath 45 cm, up and over (TERUMO)
    - If necessary, R pedal posterior tibial retrograde access (4F COOK sheath)

    2. Intra-luminal approach
    - 0.014" 4F Viance catheter, 150 cm (MEDTRONIC)
    - 0.038" Vertip catheter, 125 cm (CARDINAL HEALTH)
    - 0.014" Confianza wire, 300 cm (ABBOTT VASCULAR)
    - 0.035" Glide wire, 300 cm (TERUMO)

    3. Filter placement
    - exchanged with 0.014" Bare wire, 315 cm (ABBOTT VASCULAR)
    - Emboshield filter 4/7 mm embolic protection system (ABBOTT VASCULAR)

    4. PTA and stenting as indicated
    - Lutonix drug coated balloons 6.0/150 mm (C.R.BARD)
    - Supera stenting 5.5/100 mm (ABBOTT VASCULAR)
    View image
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    Case 02 – CGH 01: Right SFA occlusion, popliteal stenosis

    Center:
    Changi General Hospital, Singapore, Singapore
    Case 02 – CGH 01: male, 56 years (E-F)
    Operators:
    • Steven Kum,
    • Yih Kai Tan,
    • Sven Bräunlich
    CLINICAL DATA
    PAOD Rutherford 3
    Dm hypertension, hyperlipidemia, ex smoker
    EF 60% Cr 120

    PROCEDURAL STEPS
    1. Cross-over access via right groin
    - 6F Balkin sheath (COOK)

    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 PTA 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 vessel preparation
    - 5.0/100 mm Vascutrak scoring PTA catheter (C.R.BARD)

    5. PTA with DEB
    - 5/6mm Lutonix drug-coated balloon (C.R.BARD)

    6. Spot stent on indication and postdilatation
    - 5/80 mm SUPERA stent (ABBOTT)
    View image
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    Case 03 – NY 02: Severely calcified chronic total occlusion of LSFA

    Center:
    Mount Sinai Hospital, New York, USA
    Case 03 – NY 02: male, 70 years (A-K)
    Operators:
    • Prakash Krishnan,
    • Karthik Gujja,
    • Vishal Kapur
    CLINICAL DATA
    Left leg pain, Rutherford class II, category III, Fontaine IIB
    ABI R LE - 0.9 and L LE - 0.6
    US duplex showed occlusion of calcified LSFA

    RISK FACTORS
    Hypertension, diabetes mellitus type II, dyslipidemia, ex-smoker,
    CAD s/p multiple PCI's, PAD

    PROCEDURAL STEPS
    1. Right common femoral access and cross-over approach
    - 7F Pinnacle destination sheath 45 cm up and over sheath (TERUMO)

    2. Guide wire passage
    - 0.014" Spartacore wire, 300 cm (ABBOTT VASCULAR)
    - 0.038" Vertebral 135" Tempa Aqua catheter, 125 cm (CARDINAL HEALTH)
    - 0.014" Confianza wire, 300 cm (ABBOTT VASCULAR)
    - 0.035" Glide wire, 300 cm (TERUMO)

    3. Filter placement
    - exchanged with 0.014/Bare wire, 315 cm (ABBOTT VASCULAR)
    - Emboshield filter 4/7 mm embolic protection system (ABBOTT VASCULAR)

    4. Athrectomy and thrombectomy, if embolization occurs
    - Jet stream Pathway rotational athrectomy 2.4/3.4 (BOSTON SCIENTIFIC)
    - PENUMBRA aspiration thrombectomy (PENUMBRA)

    5. PTA and stenting as indicated
    - Lutonix drug coated balloons 6.0/150 mm (C.R.BARD)
    - Supera stenting 5.5/100 mm (ABBOTT VASCULAR)
    View image
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    Case 04 – NY 03: Chronic total occlusion with in-stent occlusion in mid segment RSFA

    Center:
    Mount Sinai Hospital, New York, USA
    Case 04 – NY 03: male, 76 years (J-S)
    Operators:
    • Prakash Krishnan,
    • Karthik Gujja,
    • Vishal Kapur
    CLINICAL DATA
    R leg claudication, Rutherford class II, category III, Fontaine IIB
    US duplex showed occlusion of RSFA with instent occlusion in mid RSFA

    RISK FACTORS
    Hypertension, diabetes mellitus II, dyslipidemia, ex smoker, PAD

    PROCEDURAL STEPS
    1. Left common femoral access and up and over
    - 7 Fr Pinnacle destination sheath 45 cm, up and over (TERUMO)
    - If necessary, R pedal posterior tibial retrograde access (4F COOK sheath) and direct stent access

    2. Intra-luminal approach
    - 0.014" 4F Viance catheter, 150 cm (MEDTRONIC)
    - 0.038" Vertip catheter, 125 cm (CARDINAL HEALTH)
    - 0.014" Confianza wire, 300 cm (ABBOTT VASCULAR)
    - 0.035" Glide wire, 300 cm (TERUMO)

    3. Thrombectomy
    - Angiojet Rheolytic aspiration thrombectomy (BOSTON SCIENTIFIC) or
    - PENUMBRA aspiration thrombectomy (PENUMBRA)

    4. Filter placement
    - Spider filter 7 mm (MEDTRONIC)

    5. Athrectomy and thrombectomy, if embolization occurs
    - Silver Hawk Directional athrectomy LSM (MEDTRONIC)
    - PENUMBRA aspiration thrombectomy (PENUMBRA)

    6. PTA and stenting as indicated
    - INPACT drug coated balloons 6.0/120 mm (MEDTRONIC)
    - Supera stenting 5.5/100 mm (ABBOTT VASCULAR)
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    Case 05 – CGH 02: Right SFA occlusion, iliac stenosis

    Center:
    Changi General Hospital, Singapore, Singapore
    Case 05 – CGH 02: male, 58 years (O-E)
    Operators:
    • Steven Kum,
    • Yih Kai Tan,
    • Sven Bräunlich
    CLINICAL DATA
    PAOD Rutherford 5 right ankle wound,
    Left fem-pop bypass, left CIA BMS 2 weeks ago ESRF DM EF 60%

    PROCEDURAL STEPS
    1. Brachial access via left brachial artery
    - 6F x 90 cm Shuttle sheath (COOK)

    2. Stenting of right iliac lesion
    - 8/9 mm Assurant Cobalt balloon mounted stent for CIA (MEDTRONIC)
    - 8mm Complete SE self expanding stent for EIA (MEDTRONIC)
    - Post dilatation 7/8 mm REEF HP balloon (MEDTRONIC)

    3. Passage of lesion with GW
    - 0.035“ Standard J-Tip guidewire, 150 cm (CARDINAL HEALTH)

    4. Retrograde SFA access in event of antegrade failure, rendezvous and predil via brachial
    - Pacific 4 x 120 balloon x 180 shaft length (MEDTRONIC)

    5. Antegrade right CFA access and treatment of right SFA
    - In.Pact Pacific 5/6 x 120 mm DEB-balloon (MEDTRONIC)
    - Spot-stenting with a COMPLETE SE or Everflex stent (MEDTRONIC)

    6. Consider DEB of PFA
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  • - , Room 2 - Technical Forum

    Case 12 – CGH 05: Right CLI and ATA occlusion

    Center:
    Changi General Hospital, Singapore, Singapore
    Case 12 – CGH 05: male, 66 years (T-C-B)
    Operators:
    • Steven Kum,
    • Yih Kai Tan,
    • Sven Bräunlich
    CLINICAL DATA
    CLI right 2nd toe gangrene PAOD Rutherford 5
    DM hypertension hyperlipidemia IHD EF 45% Cr 102.
    Recent cross-over POBA for SFA CTO, pop and peroneal stenosis

    PROCEDURAL STEPS
    1. Antegrade access via right groin
    - 5F TERUMO sheath

    2. Antegrade passage of the lesion with hydrophilic wire
    - 0.014" COMMAND extra support wire 300 cm (ABBOTT)
    - 2 x 40 Advance 14LP balloon (COOK)

    3. Retrograde passage of lesion via ultrasound guided DP puncture
    - 4F Micropuncture® Transpedal Set (COOK)
    - EDGE ultrasound high frequency probe (SONOSITE)
    - 0.014” COMMAND extra support wire 300 cm (ABBOTT)
    - 2 x 40 Advance Micro 14 via retrograde

    4. PTA of ATA
    - 3.0 x 120 mm Jade high pressure balloon (ORBUS NEICH)

    5. Consider DEB/stent if any SFA/pop restenosis seen
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    Case 06 – LEI 01: Restenosis after CEA right ICA 2005

    Center:
    University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
    Case 06 – LEI 01: male, 69 years (K-O)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    Progressive, asymptomatic restenosis right internal carotid artery after CEA 2005
    CEA left ICA 2007
    CAD, MI and PTCA 2012
    art. hypertension
    DUPLEX
    Progression to 3.5 m/sec. right ICA

    PROCEDURAL STEPS
    1. Access right groin
    - 9F – 20 cm sheath (TERUMO)

    2. Cannulation of the right external carotid artery
    - Judkins Right 5F diagnostic catheter (CARDINAL HEALTH)
    - 0.035" soft angled glidewire, 180 cm (TERUMO)
    - 0.035" SupraCore 300 cm stiff guidewire (ABBOTT)

    3. Cerebral protection
    - MOMA endovascular clamping device 9F (MEDTRONIC)

    4. Cannulation, predilatation, stenting and postdilatation of the right ICA
    - 0.014" Galleo Pro 175 cm guidewire (BIOTRONIK)
    - MiniTreck RX-balloon 3.5/20 mm (ABBOTT)
    - CGuard carotid embolic protection system (Inspire MD/PENUMBRA)
    - 5.0/20 mm RX-balloon (BOSTON SCIENTIFIC)
    View image
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    Case 07 – LEI 02: Reocclusion right SFA

    Center:
    University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
    Case 07 – LEI 02: female, 62 years (M-Z)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    Reocclusion right SFA
    Claudication right calf, walking capacity 150 meters, ABI right 0.67
    PTA right SFA 2012 with plane balloon angioplasty elsewhere
    PTA left SFA/stenting 2013
    Re-PTA left SFA 12/2015

    RISK FACTORS
    15 cm long reocclusion right mid SFA
    art. hypertension, former smoker, diabetes mellitus type 2

    PROCEDURAL STEPS
    1. Access left groin and cross-over approach
    - 5F diagnostic IMA-catheter (CARDINAl HEALTH)
    - 0.035" soft angled glidewire 180 cm (TERUMO)
    - 0.035" stiff SupraCore guidewire 190 cm (ABBOTT)

    2. Passage of the right SFA-CTO
    - 0.018" Cruiser S 300 cm guidewire (BIOTRONIK)
    - Passeo 4/120 mm balloon (BIOTRONIK)

    3. PTA with drug-coated balloons and stenting on indication
    - Passeo LUX DCB 5.0/120 mm (BIOTRONIK)
    - Pulsar 18 stent (BIOTRONIK)
    View image
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    Case 08 – CGH 03: Left SFA occlusion

    Center:
    Changi General Hospital, Singapore, Singapore
    Case 08 – CGH 03: female, 63 years (K-C-E)
    Operators:
    • Sven Bräunlich,
    • Steven Kum,
    • Yih Kai Tan
    CLINICAL DATA
    PAOD Rutherford 3
    COPD hypertension hyperlipidemia IHD EF 55% Cr normal

    PROCEDURAL STEPS
    1. Antegrade access via left groin 6F sheath

    2. Passage of the lesion
    - 0.018" V-18 hydrophilic control wire, 300 cm (BOSTON SCIENTIFIC)
    - 4F Ber II catheter (CARDINAL HEALTH)

    3. Predilatation and lesion preparation

    4. PTA with DEB
    - Lux 5/6 x 120 mm DEB-balloon (BIOTRONIK)

    5. Postdilatation and stent
    - Conquest 5/6 x 40 balloon (C.R.BARD)
    - 4F Pulsar 18 stent (BIOTRONIK)
    View image
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    Case 09 – LEI 03: Occlusion left SFA

    Center:
    University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
    Case 09 – LEI 03: male, 76 years (H-M)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    Severe claudication left calf, walking capacity 150 meters,
    ABI left 0.65
    Abdominal aortic aneurysm 3.2 cm
    Chronic renal insufficiency, GFR 35 ml/min
    COPD

    RISK FACTORS
    CO2-angiography: long SFA-occlusion left
    art. hypertension, former nicotin-abuse

    PROCEDURAL STEPS
    1. Access right groin and cross-over approach
    - 5F diagnostic IMA-catheter (CARDINAL HEALTH)
    - 0.035" soft angled glidewire 180 cm (TERUMO)
    - 0.035" stiff SupraCore guidewire 190 cm (ABBOTT)

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

    3. PTA and stenting
    - Advance 35 balloon (COOK)
    - Zilver-PTX drug-coated stent (COOK)
    View image
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    Case 10 – LEI 04: Popliteal occlusion right, CLI

    Center:
    University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
    Case 10 – LEI 04: male, 77 years (M-P)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    Restpain right foot, ABI right 0.44
    Failed recanalization attempt 12/2015 and 1/2016 elsewhere
    CAD, PTCA 2013 and 2014
    Minor stroke 2012

    RISK FACTORS
    Angiography during previous recanalization-attempt:
    Popliteal occlusion right, failure to pass into the posterior tibial artery
    art. hypertension, former nicotin-abuse, diabetes mellitus type 2

    PROCEDURAL STEPS
    1. Access right groin anetgrade
    - 6F 55 cm sheath (COOK)

    2. Retrograde access via posterior tibial artery
    - Transpedal access kit (COOK)
    (21 Gauge 4 cm needle, 2.9F sheath)

    3. Retrograde CTO-passage and PTA
    - 0.014" CTO-Approach guidewire 18 gramm, 300 cm (COOK)
    - CXI 0.018" angled support-catheter, 90 cm (COOK)
    - Advance Micro Balloon 3.0/80 mm, 90 cm (COOK)

    4. PTA and stenting from antegrade
    - Advance 18 5.0 mm balloon (COOK)
    - Zilver-PTX stent for the proximal popliteal artery (COOK)
    View image
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    Case 11 – CGH 04: May Thurner syndrome and GSV reflux

    Center:
    Changi General Hospital, Singapore, Singapore
    Case 11 – CGH 04: male, 58 years (P-C-M)
    Operators:
    • Steven Kum,
    • Yih Kai Tan,
    • Sven Bräunlich
    CLINICAL DATA
    Left leg swelling. Venous claudication and swelling x 100 metres
    Hypt, hyperlipidemia, AF on Dabigatran (Pradaxa), previous DVT years ago.
    CT venogram done. Duplex shows left SFJ/GSV reflux

    PROCEDURAL STEPS
    1. Left mid GSV access under ultrasound
    - 5F TERUMO sheath
    - 12F Peel-away safe-sheath (ANGIODYNAMICS)

    2. Passage of the lesion with hydrophilic wire and stiff wire
    - 0.035" Radiofocus TERUMO angled soft guidewire, 260 cm (TERUMO)
    - 4F Ber II catheter (CORDIS)
    - 0.035" Supra Core guidewire, 300 cm (ABBOTT)

    3. Venogram and IVUS
    - 8.5F Visions® PV.035 (VOLCANO)

    4. Predilatation
    - 16/18 x 40 Atlas balloon (C.R.BARD)

    5. Iliac vein stenting
    - Wallstent 18 x 90 (BOSTON SCIENTIFIC)

    6. Postdilatation and IVUS control
    - 16/18 x 40 Atlas balloon (C.R.BARD)

    7. RFA of GSV
    - Venefit with ClosureFast catheter to GSV
    View image

Conference day 2

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    Case 13 – TTC 01: Restenosis and reocclusion of left TP trunk to posterior tibial artery

    Center:
    Taipei Tzu Chi General Hospital, Taipei City, Taiwan
    Case 13 – TTC 01: male, 83 years (C-C)
    Operators:
    • Hsin-Hua Chou,
    • Hsuan Li Huang
    CLINICAL DATA
    Bilateral feet resting pain (left > right) with ulceration at left great toe for 1 month
    PTA for left TP trunk and post. tibial A 02/2013
    PTA and stenting for right SFA 01/2016, PTA for right peroneal artery 01/2016
    ESRD under regular H/D, 3-V CAD s/p PCI, Type 2 DM, HTN
    ABI: right:0.73; left:0.58

    ANGIOGRAPHY
    Stenosis at left popliteal artery, restenosis at left TP trunk to single remaining post. tibial A, reocclusion at left distal post. tibial A

    PROCEDURAL STEPS
    1. Left CFA antegrade access
    - 6F 10 cm sheath (TERUMO)
    - 6F 55 cm Multipurpose guiding catheter (BOSTON SCIENTIFIC)

    2. Passage of the lesion(s)
    - 0.014" PT2 guidewire, 300 cm (BOSTON SCIENTIFIC)
    - 0.018" CXI support-catheter, 150 cm (COOK)
    - In case of failure, exchange to V-18 control guidewire, 300 cm (BOSTON SCIENTIFIC)

    3. Lesion preparation
    - Amphirion Deep, 2.0–2.5/210 mm (MEDTRONIC)

    4. Drug-coated balloon angioplasty
    - Lutonix 014 Drug-coated balloon, 2.5/120 mm for distal post. tibial A (COOK)
    - Lutonix 014 Drug-coated balloon, 3.0/120 mm for proximal post. tibial artery (COOK)

    5. Stenting for TP trunk on indication
    - Bioabsorbable vascular scaffold 3.5/28 mm (ABBOTT)
    - With/without OCT study (ST. JUDE MEDICAL)

    6. Drug-coated balloon angioplasty
    - In.PACT Admiral drug-coated balloon 4.0/80 mm for pop. A (MEDTRONIC)
    View image
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    Case 14 – CGH 06: Left SFA and ATA occlusion, TPT stenosis

    Center:
    Changi General Hospital, Singapore, Singapore
    Case 14 – CGH 06: female, 91 years (P-M)
    Operators:
    • Steven Kum,
    • Yih Kai Tan,
    • Sven Bräunlich
    CLINICAL DATA
    Left leg shallow wounds and rest pain PAOD Rutherford 5
    DM hypertension right SFA in-stent occlusion Rotarex and DEB
    Left 4th /5th toe dermal gangrenet, EF 60%, Cr normal

    PROCEDURAL STEPS
    1. Contralateral cross-over access via right groin
    - 6F 40 cm long Balkin sheath (COOK)

    2. Passage of the lesion
    - 0.018" V-18 control wire, 300 cm (BOSTON SCIENTIFIC)
    - 0.035" TERUMO angled Soft/Stiff guide-wire, 260 cm (TERUMO)
    - 4F Ber II catheter (CORDIS)

    3. Treatment with stent /DEB
    - SUPERA 5 X 150 (ABBOTT) after predil with DORADO 6 x 40 (C.R.BARD)

    4. ATA recanalization via antegrade (retrograde DP access in event of failure)
    - 0.014" Command ES Wire (ABBOTT)
    - Armada 14 2.5/3 x 120 (ABBOTT)

    5. Treatment of TPT
    - 3.5 x 15 NC TREK balloon for TPT lesion (ABBOTT)
    - 3.5 x 28 ABSORB Bioabsorbable Vascular Scaffold/BVS (ABBOTT) for TPT lesion
    - Post Dil 3.5 x 15 NC TREK balloon (ABBOTT)
    View image
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    Case 15 – BPH 01: Left SFA long occlusion

    Center:
    Beijing PLA Hospital, Beijing, China
    Case 15 – BPH 01: female, 65 years
    Operators:
    • Wei Guo,
    • Xin Jia
    CLINICAL DATA
    Claudication of left leg for 6 months; Rutherford 3

    RISK FACTORS
    Diabetes, hypertension

    PROCEDURAL STEPS
    1. Right femoral retrograde access and cross-over
    - 6F 40 cm long sheath (COOK)

    2. Crossing the occlusion
    - 0.018" V-18 Control guidewire, 300 cm (BOSTON SCIENTIFIC)

    3. Retrograde distal SFA bailout access for unsuccessful passage

    4. Predilatation
    - 4/220 mm SAVVY Long OTW balloon, 130 cm (CORDIS)

    5. DCB and proventional stent
    - 5/200 mm Orchid DCB Balloon, 130 cm (ACOTEC)
    - 6.0/200 mm, EVERFLEX, Nitinol stent system 120 cm (EV3)
    View image
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    Case 16 – CGH 07: Left SFA in-stent occlusion

    Center:
    Changi General Hospital, Singapore, Singapore
    Case 16 – CGH 07: female, 88 years (S-A-L)
    Operators:
    • Steven Kum,
    • Yih Kai Tan,
    • Sven Bräunlich
    CLINICAL DATA
    Left leg claudication PAOD Rutherford 4
    DM hypertension hyperlipidemia PPM previous left SFA stenting

    PROCEDURAL STEPS
    1. Contralateral cross-over access via Right groin
    - 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 TERUMO angled soft guidewire, 250 cm (TERUMO)

    3. Retrograde puncture of occluded stent in event of antegrade failure
    - 0.035" Radiofocus TERUMO angled soft guidewire, 250 cm (TERUMO)
    - 4F CXI support catheter

    4. Mechanical thrombectomy and debulking
    - Predilatation with Powercross 2/3 x 120 balloon (MEDTRONIC)
    - 8F Rotarex (STRAUB MEDICAL)

    5. Post debulking IVUS
    - o.014" Eagle Eye® Platinum IVUS catheter with virtual histology

    6. Treatment with DEB and stent on indication
    View image
  • - , Room 2 - Technical Forum

    Case 23 – TTC 02: Calcified stenosis of left common femoral artery

    Center:
    Taipei Tzu Chi General Hospital, Taipei City, Taiwan
    Case 23 – TTC 02: male, 60 years, (Chen)
    Operators:
    • Hsuan Li Huang,
    • Hsin-Hou Chou
    CLINICAL DATA
    Intermittent claudication of left leg for months
    Diabetes mellitus, arterial hypertension, hyperlipidemia
    Duplex US showed the dampened waveform distal to CFA
    The ABI levels: left 0.77, right 0.89
    CTA: heavily calcified stenosis involving Lt CFA, mild stenosis at left middle SFA

    PROCEDURAL STEPS
    1. Right femoral cross-over access
    - 8F Balkin 40 cm cross-over sheath (COOK)

    2. Guidewire passage and distal protection
    - 0.014" PT2 guidewire 300 cm (BOSTON SCIENTIFIC)
    - Spider FX embolic protection device (MEDTRONIC-COVIDIEN)

    3. IVUS assessment
    - Visions® PV 0.018 catheter (VOLCANO)

    4. Directional atherectomy
    - Turbohawk LS-C or LX-C (MEDTRONIC-COVIDIEN)

    5. Drug coated balloon angioplasty
    - In.PACT Admiral 0.035" 7.0/60 mm (MEDTRONIC)
    View image
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    Case 17 – LEI 05: SFA occlusion left

    Center:
    University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
    Case 17 – LEI 05: male, 61 years (K-M)
    Operators:
    • Matthias Ulrich,
    • Andrej Schmidt
    CLINICAL DATA
    Severe claudication left calf, walking capacity 200 meters, ABI left 0.67
    CAD, PTCA 2013

    DUPLEX
    Long SFA-occlusion left

    RISK FACTORS
    Art. hypertension, nicotin abuse

    PROCEDURAL STEPS
    1. Access right groin and cross-over approach
    - 5F diagnostic IMA-catheter (CARDINAl HEALTH)
    - 0.035" soft angled glidewire 180 cm (TERUMO)
    - 0.035" stiff SupraCore guidewire 190 cm (ABBOTT)

    2. Guidewire passage
    - Mustang balloon 5.0/120 mm (BOSTON SCIENTIFIC)
    - 0.035" stiff angled glidewire, 260 cm (TERUMO)
    in case of failure to reenter distal:
    - attempt with Victory 18 30 gramm 300 cm (BOSTON SCIENTIFIC)

    3. PTA with drug-coated balloons and stenting on indication
    - Ranger DCB (BOSTON SCIENTIFIC)
    - EPIC selfexpanding nitinol-stent (BOSTON SCIENTIFIC)
    View image
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    Case 18 – CGH 08: May Thurner syndrome

    Center:
    Changi General Hospital, Singapore, Singapore
    Case 18 – CGH 08: female (J-L)
    Operators:
    • Yih Kai Tan,
    • Steven Kum,
    • Sven Bräunlich
    CLINICAL DATA
    Left leg swelling. Recent cellulitis
    Hypothyroidism, recent left calf DVT on Warfarin.
    CT venogram done.

    PROCEDURAL STEPS
    1. Left mid SFV access under ultrasound
    - 5F TERUMO sheath
    - 12F Peel-away Safe-sheath (ANGIODYNAMICS)

    2. Passage of the lesion with hydrophilic wire and stiff wire
    - 0.035" Radiofocus TERUMO angled soft guidewire, 260 cm (TERUMO)
    - 4F Ber II catheter (CORDIS)
    - 0.035" Supra Core guidewire, 300 cm (ABBOTT)

    3. Venogram and IVUS
    - 8.5F Visions® PV.035 (VOLCANO)

    4. Predilatation
    - 16/18 x 40 Atlas balloon (C.R.BARD)

    5. Iliac Vein Stenting
    - Wallstent 18 x 90 (BOSTON SCIENTIFIC)

    6. Postdilatation and IVUS control
    - 16/18 x 40 Atlas balloon (C.R.BARD)
    View image
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    Case 19b – LEI 06B: 3-vessel occlusion right BTK, CLI

    Center:
    University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
    Case 19b – LEI 06B: male, 81 years (F-F)
    Operators:
    • Andrej Schmidt,
    • Yvonne Bausback
    CLINICAL DATA
    PAOD Rutherford 5, forefoot right
    SFA-Angioplasty right 02/2016
    CAD, PTCA 8/2013
    Diabetes mellitus type 2
    former smoker

    ANGIOGRAPHY
    Occlusion of all 3 BTK vessels,
    collateral filling of the distal peroneal artery and dorsalis pedis artery

    PROCEDURAL STEPS
    1. Antegrade access right groin
    - 5F 55 cm Flexor Check-Flo introducer (COOK)

    2. Antegrade passage and PTA
    - Command ES guidewire 300 cm (ABBOTT)
    - Ultraverse 0.014" balloon 2.0/120 mm (C.R.BARD)
    - VascuTrak 2.5/250 mm Balloon (C.R.BARD)

    3. In case of antegrade failure:
    retrograde puncture of the dorsalis pedis/peroneal artery

    - 21 Gauge / 7 cm needle (COOK)
    - Connect 300 cm guidewire (ABBOTT)
    - Seeker support catheter 0.018" 90 cm (C.R.BARD)

    4. PTA with DCBs
    - Lutonix 2.5/150 mm DCB (C.R.BARD)
    View image
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    Case 22 – LEI 08: Forefoot ulcerations right, Bullfrog-PTA

    Center:
    University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
    Case 22 – LEI 08: female, 79 years (I-S)
    Operators:
    • Andrej Schmidt,
    • Yvonne Bausback
    CLINICAL DATA
    PAOD Rutherford 5, forefoot-ulcerartion right, restpain toes
    ABI right 0.22
    PTA of a popliteal stenosis right,
    failure to recanalize a posterior tibial occlusion from antegrade
    CAD, PTCA 2004
    Diabetes mellitus type 2 with diabetic nephropathy, GFR 53 ml/min
    paroxysmal atrial fibrillation
    BTK: patent peroneal artery, flush-occlusion of the posterior tibial artery

    PROCEDURAL STEPS
    1. Antegrade access right groin
    - 6F 55 cm Flexor Check-Flo introducer (COOK)

    2. Retrograde passage via the posterior tibial artery
    - transpedal puncture-kit (COOK)
    (4 cm 21 gauge needle, 2.9F sheath)
    - CXI 0.018" 90 cm support catheter (COOK)
    - CTO-Approach 0.014" guidewire, 18 gramm, 300 cm (COOK)
    - Advance Micro-balloon 2.5/120 mm (COOK)

    3. PTA and arterial wall-injection of dexamethason
    - BullFrog Micro-Infusion-Device (MERCATOR MEDSYSTEMS)
    View image

Conference day 3

  • - , Room 1 - Main Arena 1

    Case 24 – TAI 01: Right common iliac artery aneurysm

    Center:
    Taipei Veterans General Hospital, Taipei City, Taiwan
    Case 24 – TAI 01: male, 71 years (HSU,T-S)
    Operators:
    • Chun-Che Shih,
    • Po-Lin Chen,
    • I-Ming Chen
    CLINICAL DATA
    Right common iliac artery aneurysm 4 cm
    Hypertension, hyperlipidemia

    PROCEDURAL STEPS
    1. Main body of AAA stent graft (ENDURANT II, MEDTRONIC)
    - 32-16-124 mm from left

    2. Home-made fenestration graft for RIIA
    - 13-13-82 mm iliac limb (MEDTRONIC)

    3. RIIA covered stent
    - 7F 90 cm Flexor Check-Flo Performer from left brachial artery (COOK)
    - 10-59 mm Advanta V12 covered stent (ATRIUM)

    4. Left iliac limb
    - 16-24-82 mm (MEDTRONIC)

    5. Right iliac bridging limb
    - 16-16-82 mm (MEDTRONIC)

    6. Postdilatation
    - Reliant balloon (MEDTRONIC)
    View image
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    Case 25 – SGH 01: Chimney EVAS

    Center:
    Singapore General Hospital, Singapore, Singapore
    Case 25 – SGH 01: male, 65 years (CKM)
    Operators:
    • Tze Tec Chong ,
    • Kiang Hiong Tay
    CLINICAL DATA
    Asymptomatic 6.9cm AAA
    Ex-smoker, hypertensive, hyperlipidaemia, chronic obstructive airway disease,
    ischemic heart disease, mulitnodular goitre, chronic kidney disease (baseline sCr 300+),
    anaemia of chronic illness (Hb 7 to 8 g/dl), Ca prostate (conservative treatment)
    Ischemic bowel s/p subtotal colectomy and ileostomy in 2009

    PROCEDURAL STEPS
    1. Bilateral femoral arterial punctures, US guided,
    pre close with Proglide x 2 each side.
    Bilateral brachial arterial punctures, US guided, 6F sheaths

    2. Both renal arteries cannulated from brachial approach with TERUMO glidewire
    and MPA catheter. Exchanged for Rosen wire and 7F x 90cm Destination sheaths
    (TERUMO) to introduce 5x38 mm BeGraft (INNOMED) for renal chimneys

    3. Nellix device introduced from below over Lunderquist wires.
    Test fill endobags with saline followed by angio run
    to confirm good aneurysm seal/exclusion.

    4.Fill endobags with polymer and allow to cure.
    Check for endoleaks. Secondary fill if needed.
    View image
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    Case 26 – BPH 03: Acute aortic dissection (stanford type B)

    Center:
    Beijing PLA Hospital, Beijing, China
    Case 26 – BPH 03: male, 55 years
    Operators:
    • Wei Guo,
    • Xin Jia
    CLINICAL DATA
    Acute back pain 20 days ago
    Maximal thoracic aortic diameter 5.0 cm

    RISK FACTORS
    Hypertension, smoking

    PROCEDURAL STEPS
    1. Left brachial access for angiogram

    2. Right femoral access – preclose technique
    - Proglide preloaded (ABBOTT)

    3. Stentgraft implantation
    - 32-26-200 Castor branched stentgraft (MICORPORT)
    View image
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    Case 27 – SGH 02: Left brachiocephalic vein occlusion

    Center:
    Singapore General Hospital, Singapore, Singapore
    Case 27 – SGH 02: male, 70 years (DFN)
    Operators:
    • Ankur Patel,
    • Sum Leong
    CLINICAL DATA
    Recurrent left arm swelling
    Diabetic, hypertensive, hyperlipidaemia, ischaemic heart disease.
    End stage kidney disease on hemodialysis via left arm brachiocephalic AVF x 6 years.

    CURRENT STATE
    Had left arm swelling 3 months ago due to left brachiocephalic vein occlusion treated successfully with balloon angioplasty. Now symptoms recurred.

    PROCEDURAL STEPS
    1. Antegrade puncture of left BCAVF, 7F sheath

    2. Lesion crossing
    - 0.035 TERUMO glidewire and 4F Ber catheter
    - Right femoral approach if lesion crossing failed via arm approach.

    3. Angioplasty
    - 14.0/40 mm Conquest balloon (C.R.BARD)

    4. Stenting if poor result
    - Sinus XL stent (OPTIMED)
    View image
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    Case 28 – TAI 02: AV graft stenosis

    Center:
    Taipei Veterans General Hospital, Taipei City, Taiwan
    Case 28 – TAI 02: female, 41 years (HSU,T-S)
    Operators:
    • Po-Lin Chen,
    • I-Ming Chen
    CLINICAL DATA
    ESRD s/p PD for 2 years, shifted to HD since 2013/07 due to peritonitis
    Right forearm loop AVG was created on 2013/08. High pressure since 2014/12
    Type 1 DM, hypertension
    Left renal cell carcinoma s/p laparoscopic radial nephrectomy in 2014

    PROCEDURAL STEPS
    1. Antegrade puncture of AV graft
    - 7F 5 cm sheath (TERUMO)

    2. PTA to venous anastomosis and basilic vein with DEB
    - 6/80 mm Admiral (MEDTRONIC)
    - 7/80 mm InPact Admiral DEB (MEDTRONIC)
    View image
  • - , Room 1 - Main Arena 1

    Case 32 – LEI 10: Popliteal occlusion right, CLI

    Center:
    University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
    Case 32 – LEI 10: male, 57 years (P-K)
    Operators:
    • Andrej Schmidt,
    • Yvonne Bausback
    CLINICAL DATA
    PAOD Rutherford 4, Restpein right foot
    ABI left 0.44
    PTA left SFA and popliteal artery 1/2016
    CEA right groin 2012

    RISK FACTORS
    Diabetes mellitus type 2, current smoker

    ANGIOGRAPHY
    Occlusion distal SFA / Apop artery right

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

    2. Guidewire passage:
    - 0.018" Connect guidewire, 300 cm (ABBOTT)
    - CXC 0,018" 90 cm support catheter (COOK)
    In case of failure:
    - 0.035" stiff angled glidewire (TERUMO)
    - CXC 0,035" 90 cm support catheter (COOK)
    If failure:
    retrograde access via posterior tibial artery

    3. PTA and stenting
    - Armada 35 balloon (ABBOTT)
    - Supera Interwoven nitinol stent (ABBOTT)
    View image