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)
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)
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)
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)
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)
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
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)
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)
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