University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
11 livecase(s)
Tuesday, March 8th:
-
,
Room 1 - Main Arena 1
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)
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)
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)
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)
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)
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)
University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
Case 19a – LEI 06A: male, 61 years (F-H)
Operators:
Andrej Schmidt,
Matthias Ulrich
CLINICAL DATA
Severe claudication right calf, walking capacity 100 meters,
ABI right 0.54
CAD, MI and PTCA 2012
Renal artery stenosis PTA 2013
COPD
failed antegrade recanalization attempt right SFA 2/2016
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. Guidewire passage of the right SFA-flush-occlusion
- 0.035" stiff angled glidewire, 260 cm (TERUMO)
- 5F diagnostic IMA-catheter (CARDINAl HEALTH)
In case of failure to enter the CTO retrograde approach via distal SFA:
- 9 cm 21 Gauge needle (COOK)
- 0.018" V-18 Control guidewire 300 cm (BOSTON SCIENTIFIC)
- 0.018" Seeker support catheter 90 cm (C.R.BARD)
3. PTA and stenting on indication
- VascuTrak scoring balloon 5.0/300 mm (C.R.BARD)
- Lutonix 5.0 or 6.0 150 mm DCB (C.R.BARD)
- Lifestent (C.R.BARD)
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)
University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
Case 21 – LEI 07: male, 57 years (D-R)
Operators:
Andrej Schmidt,
Matthias Ulrich
CLINICAL DATA
PAOD Rutherford 4, restpain right, severe claudication, walking capacity 100 meters
ABI right 0.44
Aortic valve replacement 2009
Diabetes mellitus type 2
former smoker
PTA of a proximal SFA-stenosis right 1/2016,
failed antegrade passage of the popliteal occlusion right
PROCEDURAL STEPS 1. Antegrade access right groin
- 7F 55 cm Flexor Check-Flo Introducer (COOK)
2. Retrograde passage via the anterior tibial artery
- 7 cm 21 gauge needle (COOK)
- 0.018" QuickCross support catheter 90 cm (SPECTRANETICS)
- 0.018" Connect guidewire 300 cm (ABBOTT)
- Snaring of the retrograde guidewire from retrograde
3. Atherectomy
- 4 mm Spider filter (MEDTRONIC)
- HawkOne 6 cm tip (MEDTRONIC)
4. PTA with DCBs
- In.Pact Pacific DCB (MEDTRONIC)
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)
Case 30 – LEI 09: Iliac occlusion left with failed recanalization attempt
Center:
University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
Case 30 – LEI 09: male, 54 years (J-K)
Operators:
Andrej Schmidt,
Matthias Ulrich
CLINICAL DATA
PAOD Rutherford 3, severe claudication left leg
ABI left 0.71
Stenting right common iliac artery 2012,
Unsuccessful recanalizaiton attempt left CIA 1/2016 elsewhere
CAD, PTCA 6/2015
Diabetes mellitus type 2, current smoker
ANGIOGRAPHY
Common iliac occlusion left, plaque distal abdominal aorta, stent CIA right patent
PROCEDURAL STEPS 1. Left brachial access
- 7F 90 cm Check-Flow-Performer sheath (COOK) Left femoral approach
- 11F 25 cm Radiofocus II sheath (TERUMO)
2. Guidewire passage of the occlusion left CIA
transbrachial:
- 5F 125 cm Judkins Right Diagnostic catheter (CARDINAL HEALTH)
- 0.035" stiff angled glidewire, 260 cm (TERUMO)
left femoral:
- 5F 80 cm Multipurpose Diagnostic catheter (CARDINAL HEALTH)
- 0.035" stiff angled glidewire, 260 cm (TERUMO)
- potentially double-balloon technique
3. Stenting
- Sinus aortic stent for the abdominal aorta (OPTIMED)
- Lifestream 8/57 mm covered stent left CIA (C.R.BARD)
- Lifestream 8/37 mm covered stent right CIA (C.R.BARD)
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)
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