LINC Asia-Pacific 2017 live case guide

Find all live cases and live case centers listed below.

Conference day 1

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    Case 01 – Left SFA occlusion

    Center:
    Singapore, Changi General Hospital
    Case 01 – CGH 01: male, 70 years, (TGL)
    Operators:
    • Sven Bräunlich,
    • Steven Kum,
    • Tan Yih Kai,
    • Darryl Lim,
    • Derek Lim
    CLINICAL DATA
    PAOD Rutherford 3
    COPD hypertension hyperlipidemia EF 40% Cr normal

    PROCEDURAL STEPS
    1. Crossover access via right groin 6F sheath
    - Passage of the lesion with hydrophilic wire 0.018" V-18 control wire, 300 cm (BOSTON SCIENTIFIC)
    - 4F Ber II catheter (CORDIS)

    2. Retrograde SFA approach in event of antegrade failure

    3. Predilatation and lesion preparation, consider debulking

    4. PTA with DCB or stent (DES)
    - Ranger 5/6 x 100 (BOSTON SCIENTIFIC)
    - Eluvia 6 x 150 (BOSTON SCIENTIFIC)

    5. Post dilatation and stenting
    - Mustang 5/6 x 40 balloon (BOSTON SCIENTIFIC)
    View image
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    Case 02 – SFA-CTO left

    Center:
    Beijing
    Case 02 – BPH 01: male, 78 years (YH-W)
    Operators:
    • Xin Jia,
    • Zhang Minhong
    CLINICAL DATA
    Severe claudication left calf, walking capacity 100 meters

    IMPORTANT ITEMS
    DM type 2, hypertension, former smoker
    ABI: left 0.61
    Rutherford 3
    CTA: moderately calcified SFA-CTO left

    PROCEDURAL STEPS
    1. Right femoral access and cross-over approach
    - 6F 55 cm sheath (COOK)

    2. Passage of the occlusion left SFA
    - 0.018" V18 guidewire, 300 cm (BOSTON SCIENTIFIC)
    - 0.018" Trailblazer support catheter, 135 cm (MEDTRONIC)

    3. Retrograde approach via the distal SFA right in case of failure to pass from antegrade
    - 21 Gauge 9 cm Micropuncture needle (COOK)
    - 0.018" V18 guidewire, 300 cm (BOSTON SCIENTIFIC)
    - 0.018" Trailblazer support catheter, 90 cm (MEDTRONIC)

    4. PTA and stenting on indication
    - Passeo18 ballon 3 x 100 mm, 4 x 100 mm (BIOTRONIK)
    - Orchid DCB 5.0/120 mm (ACOTEC SCIENTIFIC)
    - Smart Control stent (CORDIS)

    5. Puncture site closure
    - Exoseal 6F (CORDIS)
    View image
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    Case 03 – Right SFA in-stent occlusion

    Center:
    Singapore, Changi General Hospital
    Case 03 – CGH 02: male, 70 years (V-F)
    Operators:
    • Steven Kum,
    • Tan Yih Kai,
    • Sven Bräunlich,
    • Darryl Lim,
    • Derek Lim
    CLINICAL DATA
    PAOD Rutherford 3

    RISK FACTORS
    DM, hypertension, smoker, allergic to Plavix

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

    2. Passage of the lesion with hydrophilic wire
    - 0.035" Terumo angled soft/stiff guidewire, 260 cm (TERUMO)
    - 0.018" V-18 control wire, 300 cm (BOSTON SCIENTIFIC)
    - 4F Ber II catheter (CORDIS)

    3. Retrograde stent puncture in event of antegrade failure
    - 0.018" V-18 control wire, 300 cm (BOSTON SCIENTIFIC)
    - 0.035" Terumo angled soft/stiff guidewire, 260 cm (TERUMO)

    4. Predilatation and vessel preparation, consider debulking
    - 5.0 mm Pacific (MEDTRONIC)

    5. PTA with DEB
    - 5/6mm InPact Pacific (MEDTRONIC)

    6. Consider treatment of PFA
    View image
  • - , Room 2 - Technical Forum

    Case 10 – CAS of a progressive internal artery stenosis

    Center:
    Leipzig, Dept. of Angiology
    Case 10 – LEI 05: male, 67 years (S-R)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    Progressive stenosis left internal carotid artery stenosis
    Minor stroke left hemispheric 1/2012
    CAD, CABG 2012

    RISK FACTORS
    Art. Hypertension, diabetes mellitus type II, former smoker

    PRESENT STATE
    Duplex: PSV left 5.2 m/sec.
    MR-angiography: high grade stenosis left ICA;
    intracranial MR without pathological findings

    PROCEDURAL STEPS
    1. Right groin access
    - 9F 25 cm sheath (TERUMO)

    2. Cannulation of the left external carotid artery
    - 5F Judkins right diagnostic catheter (CARDINAL HEALTH)
    - 0.035" soft angled glidewire, 190 cm (TERUMO)
    - Exchange to 0.035" SupraCore guidewire, 190 cm (ABBOTT)

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

    4. Predilatation, stenting, and postdilatation
    - 3.5/20 mm MiniTrek RX balloon (ABBOTT)
    - Roadsaver carotid artery stent system (TERUMO)
    - 5.0/20 mm Sterling RX balloon (BOSTON SCIENTIFIC)

    5. Aspiration of potential plaque-debris before declamping of the MOMA-system

    6. Final angiography
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    Case 04 – Long, calcified SFA-CTO right

    Center:
    Beijing
    Case 04 – BPH 02: female, 80 years (X-SY)
    Operators:
    • Wei Guo,
    • Xiong Jiang
    CLINICAL DATA
    Rest pain right calf

    IMPORTANT ITEMS
    CHD, DM type 2, hypertension, hyperlipidimia
    ABI 0.4 right
    Rutherford 4
    CTA: Long SFA and BTK occlusion right, moderately calcified

    PROCEDURAL STEPS
    1. Left femoral access and cross-over approach
    - 0.035" angled soft Radiofocus guidewire, 260 cm (TERUMO)
    - 0.035" SupraCore guidewire, 300 cm (ABBOTT)
    - 4F 70 cm Sheath (COOK)

    2. Passage of the occlusion right SFA
    - 0.018" V18 guidewire, 300 cm (BOSTON SCIENTIFIC)
    - 0.018" Trailblazer support catheter, 135 cm (MEDTRONIC)

    3. Retrograde approach via the popliteal artery right, in case of failure to pass from antegrade
    - 21 Gauge 9 cm Micropuncture needle (COOK)
    - 0.018" V18 guidewire, 300 cm (BOSTON SCIENTIFIC)
    - 0.018" Trailblazer support catheter, 90 cm (MEDTRONIC)

    4. PTA and stenting on indication
    - Passeo18 ballon 4 x 170 mm (BIOTRONIK)
    - Pulsar18 stent 5 x 200 mm (BIOTRONIK)
    View image
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    Case 05 – Chronic total occlusion left SFA

    Center:
    Leipzig, Dept. of Angiology
    Case 05 – LEI 01: male, 66 years (J-R)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    Severe claudication left calf, Rutherford class 3
    CAD, MI 2002, PCA 2002 and 2016

    RISK FACTORS
    Nicotin abuse, art. Hypertension

    PRESENT STATE
    ABI left 0.67
    Angiography during coronary angiography: long SFA-CTO left

    PROCEDURAL STEPS
    1. Access right groin and cross-over approach
    - 5F diagnostic IMA-catheter (CORDIS/CARDINAl HEALTH)
    - 0.035" soft angled glidewire 180 cm (TERUMO)
    - 0.035" stiff SupraCore guidewire 190 cm (ABBOTT)
    - 5F Fortress Cross-over sheath 45 cm (BIOTRONIK)

    2. Guidewire passage
    - 0.035" stiff angled glidewire (TERUMO)
    - 0.018" Cruiser guidewire (BIOTRONIK)

    3. PTA with drug-coated balloons and stenting on indication
    - Passeo 18 balloon 5.0/120 mm for predilatation (BIOTRONIK)
    - Passeo LUX DCB 5.0/120 mm (BIOTRONIK)
    - Pulsar 18 stent (BIOTRONIK)
    View image
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    Case 06 – Chronic occlusion left SFA, reocclusion

    Center:
    Leipzig, Dept. of Angiology
    Case 06 – LEI 02: male, 55 years (M-L)
    Operators:
    • Andrej Schmidt,
    • Yvonne Bausback
    CLINICAL DATA
    Severe claudication left calf, Rutherford class 3
    PTA left CFA and SFA 2/2015
    CAD, PTCA 2012

    RISK FACTORS
    Nicotine abuse, art. Hypertension

    PRESENT STATE
    ABI left 0.67

    PROCEDURAL STEPS
    1. Access right groin and cross-over approach
    - 5F diagnostic IMA-catheter (CORDIS/CARDINAL HEALTH)
    - 0.035" soft angled glidewire 180 cm (TERUMO)
    - 0.035" stiff SupraCore guidewire 190 cm (ABBOTT)
    - 6F 40 cm Up&Over Sheath, 40 cm (COOK)

    2. Passage of the left SFA-CTO
    - 0.018" Connect Guidewire, 300 cm (ABBOTT)
    - CXC 0.018" 135 cm support catheter (COOK)

    3. Predilatation and stenting
    - Advance balloon 5.0/100 mm (COOK)
    - 14 cm 6 mm Zilver-PTX stent (COOK)
    View image
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    Case 07 – CTO left distal SFA, CLI

    Center:
    Leipzig, Dept. of Angiology
    Case 07 – LEI 03: male, 65 years (S-P)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    Critical limb ischemia left, ulceration Dig II and III left, Restpain, Rutherford class 5
    Bypass-occlusion both sides (P1 left)
    PTA right SFA 02/2017, CAD, PTCA 2010

    RISK FACTORS
    Art. Hypertension, diabetes mellitus, former nicotine abuse

    PRESENT STATE
    ABI right 0.72; left 0.3
    Angiography left: distal calcified SFA-CTO, BTK 3-vessel occlusion

    PROCEDURAL STEPS
    1. Left antegrade approach
    - 6F 20 cm Radiofocus Introducer Sheath (TERUMO)

    2. Guidewire passage of the SFA-CTO
    - 0.018" Connect 250 T guidewire, 300 cm (ABBOTT)
    - CXC 0.018" support catheter, 90 cm (COOK)

    3. Vessel preparation for the stent implantation
    - Advance Enforcer 35 Focal Force PTA balloon 6.0/40 mm, 50 cm (COOK)

    4. Stenting
    - Zilver-PTX 7/80 mm (COOK)
    View image
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    Case 08 – Left SFA occlusion, TPT occlusion

    Center:
    Singapore, Changi General Hospital
    Case 08 – CGH 03: male, 56 years (P)
    Operators:
    • Steven Kum,
    • Tan Yih Kai,
    • Sven Bräunlich,
    • Darryl Lim,
    • Derek Lim
    CLINICAL DATA
    PAOD Rutherford 3
    Dm Hypertension, hyperlipidemia, ex-smoker, normal renal function

    PROCEDURAL STEPS
    1. Crossover access via left groin
    - 6F Balkin sheath (COOK)
    2. Passage of the lesion with hydrophilic wire
    - 0.018" V-18 control wire, 300 cm (BOSTON SCIENTIFIC)
    - 0.035" Terumo angled soft/stiff guidewire, 260 cm (TERUMO)
    - 4F Ber II catheter (CORDIS)

    3. Retrograde SFA access in event of antegrade failure
    - 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 (BARD)

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

    6. Spot stenting on indication and post dilatation
    - 5 mm SUPERA stent (ABBOTT)

    7. 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 dilatation 3.5 x 15 NC TREK balloon (ABBOTT)
    View image
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    Case 09 – CLI with long BTK-occlusions

    Center:
    Leipzig, Dept. of Angiology
    Case 09 – LEI 04: male, 73 years (K-M)
    Operators:
    • Andrej Schmidt,
    • Yvonne Bausback
    CLINICAL DATA
    CLI with ulceration left dig 2, restpain
    PTA/stent left popliteal artery 1/2016
    Amputaiton dig 1 left 1/2016
    Reocclusion left popliteal artery, Rotarex-thrombectomy 12/2016

    RISK FACTORS
    Former smoker, art. Hypertension

    PRESENT STATE
    Angiography 12/2016, ABI left 0.2

    PROCEDURAL STEPS
    1. Antegrade approach left
    - 5F 55 cm Check-Flo sheath (COOK)

    2. Guidewire passage left ATA
    - 0.014" PT2 guidewire, 300 cm (BOSTON SCIENTIFIC)
    - Ultraverse 0.014" balloon as support (BARD)

    In case of failure to pass from antegrade:
    3. Retrograde approach via the dorsalis pedis artery
    - Transpedal access set: 21 Gauge needle, 2.9F sheath (COOK)

    4. PTA
    - 2.5/250 mm VascuTrak scoring balloon (BARD)

    5. Drug-coated balloon treatment
    - Lutonix 2.5/150 mm and 3.0/150 mm drug-coated balloons (BARD)
    View image

Conference day 2

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    Case 11 – Complex calcified left common iliac artery stenosis

    Center:
    New York
    Case 11 – MSH 01: female, 83 years (A-M)
    Operators:
    • Prakash Krishnan,
    • Vishal Kapur,
    • Karthik Gujja,
    • Farhan Majeed,
    • Rheoneil Lascano
    CLINICAL DATA
    Patient presents with 1 block life-style limiting severe left lower extremity claudication.
    Rutherford grade 1, category 3. Fontaine stage IIB. Claudication symptoms have been getting progressively worse over the last few weeks. No rest pain or ischemic ulcers noted.
    Left ABI 0.52. Right ABI 0.96.

    RISK FACTORS
    Hypertension, hyperlipidemia, peripheral arterial disease s/p
    right femoral-popliteal bypass (patent) and left femoral-popliteal bypass (patent),
    diabetes mellitus, and tobacco use

    PROCEDURAL STEPS
    1. Left groin access with retrograde approach
    - 0.035" SupraCore guidewire, 300 cm (ABBOTT VASCULAR)
    - 7F – 25 cm Pinnacle sheath (TERUMO)

    2. Passage through the left common iliac artery stenosis
    - 0.035" SupraCore guidewire, 300 cm (ABBOTT VASCULAR)

    3. Imaging for anatomical clarification
    - Volcano 0.035" Peripheral IVUS (PHILLIPS)

    4. PTA of the left common iliac artery with balloon
    - Armada 6 x 20 mm balloon (ABBOTT VASCULAR)

    5. Covered stent of the left common iliac artery
    - Atrium iCast covered stent 10 x 38 mm (GETINGE)
    View image
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    Case 12 – Right SFA long occlusion

    Center:
    Gwangju
    Case 12 – CNUH 01: male, 85 years
    Operators:
    • Jae Kyu Kim,
    • Nam Yeol Yim
    CLINICAL DATA
    Mild claudication right leg, walking distance 200 meters
    ABI 0.65/0.86 (PT)
    Left iliac artery occlusion: Stent, left SFA and popliteal artery multiple stenosis: Stent, LUTONIX DCB. 02/2017
    Lower abdominal aorta stenosis: stent. 02/2011

    RISK FACTORS
    Hypertension medications

    PROCEDURAL STEPS
    1. Access left groin and cross-over approach/antegrade approach
    - 7F Ansel sheath 45 cm (COOK)

    2. Passage of the lesion with hydrophilic guide wire
    - 5F Headhunter diagnostic catheter (BOSTON SCIENTIFIC)

    3. Predilation and vessel preparation
    - 5.0/100 mm Vascutrack scoring PTA catheter (BARD)

    4. PTA with DEB
    - LUTONIX drug coated balloon catheter (BARD) 6.0/150 mm

    5. Spot stenting if necessary
    - LIFE stent (BARD) 6.0 mm
    View image
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    Case 13 – Heavily calcified right superficial femoral artery disease

    Center:
    New York
    Case 13 – MSH 02: female, 78 years (S-P)
    Operators:
    • Prakash Krishnan,
    • Vishal Kapur,
    • Karthik Gujja,
    • Farhan Majeed,
    • Rheoneil Lascano
    CLINICAL DATA
    Patient presents with 1 block life-style limiting severe right lower extremity claudication.
    Rutherford grade 1, category 3. Fontaine stage IIB. Claudication symptoms have been progressive. Symptoms have been persistent despite exercise program and medical therapy. No rest pain or ischemic ulcers noted.
    Right ABI 0.46. Left ABI 0.65

    RISK FACTORS
    Hypertension, hyperlipidemia, peripheral arterial disease s/p right common iliac
    artery stent, left common iliac artery stent, and left superficial femoral artery stent,
    diabetes mellitus, and tobacco use.

    PROCEDURAL STEPS
    1. Left groin access with retrograde cross over approach
    - UF 4F diagnostic catheter (ANGIODYNAMICS)
    - 0.035" SupraCore guidewire, 300 cm (ABBOTT VASCULAR)
    - 7F – 45 cm Pinnacle sheath (TERUMO)

    2. Passage through the right SFA calcified stenosis
    - 0.018" Trailblazer Vert support catheter, 135 cm (MEDTRONIC)
    - 0.014" Fielder guidewire, 300 cm (ASAHI)

    3. Filter placement
    - Fielder exchanged to a Barewire through the support catheter (ABBOTT VASCULAR)
    - Emboshield Nav 6 filter placement (ABBOTT VASCULAR)

    4. Jetstream atherectomy of the right SFA calcified disease
    - Jetstream 2.4/3.4 mm atherectomy (BOSTON SCIENTIFIC)
    - or: TurboHawk directional atherectomy (MEDTRONIC)

    5. PTA with a non-compliant balloon
    - Dorado 6 x 200 mm balloon (BARD)

    6. Drug-coated balloon therapy
    - In-Pact Admiral 6 x 150 mm balloon (MEDTRONIC)

    7. Stenting
    - 5.5 x 150 mm Supera interwoven self-expanding Nitinol stent (ABBOTT)
    View image
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    Case 14 – Left SFA multifocal stenosis

    Center:
    Gwangju
    Case 14 – CNUH 02: male, 77 years
    Operators:
    • Jae Kyu Kim,
    • Nam Yeol Yim
    CLINICAL DATA
    Mild claudication right leg, walking distance 200 meters
    ABI 0.6/0.5

    RISK FACTORS
    Hypertension

    PROCEDURAL STEPS
    1. Access left groin antegrade
    - 5/6F Ansel sheath 45 cm (COOK)

    2. Passage of the lesion with hydrophilic guide wire
    - 2.35" 90 cm CXI support catheter (COOK)
    - 0.014" 300 cm V 18 control guidewire (BOSTON SCIENTIFIC)

    3. PTA with DEB
    - LUTONIX drug coated balloon catheter (BARD) 6.0/150 mm

    4. Spot stenting if necessary
    - LIFE stent (BARD) 6.0 mm
    View image
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    Case 15 – Long left superficial femoral artery in-stent occlusion

    Center:
    New York
    Case 15 – MSH 03: male, 78 years (R-A)
    Operators:
    • Prakash Krishnan,
    • Vishal Kapur,
    • Karthik Gujja,
    • Farhan Majeed,
    • Rheoneil Lascano
    CLINICAL DATA
    Patient presents with 1/2 block life-style limiting severe left lower extremity claudication.
    Rutherford grade 1, category 3. Fontaine stage IIB.
    Claudication symptoms have been progressive. No rest pain or ischemic ulcers noted.
    Left ABI 0.40

    RISK FACTORS
    Hypertension, hyperlipidemia, peripheral arterial disease s/p previous right and
    left superficial femoral artery stents, diabetes mellitus, and tobacco use

    PROCEDURAL STEPS
    1. Right groin access with retrograde cross over approach
    - UF 4F diagnostic catheter (ANGIODYNAMICS)
    - 0.035" SupraCore guidewire, 300 cm (ABBOTT VASCULAR)
    - 7F – 45 cm Pinnacle sheath (TERUMO)

    2. Passage through the left SFA instent restenosis
    - 0.035" Trailblazer Vert support catheter, 135 cm (MEDTRONIC)
    - 0.035" Stiff Angled Glidewire, 260 cm (TERUMO)

    3. Filter placement
    - Glidewire exchanged to a Barewire through the support catheter (ABBOTT VASCULAR)
    - Emboshield Nav 6 filter placement (ABBOTT VASCULAR)

    4. Mechanical thrombectomy of the left SFA disease
    - Angiojet mechanical thrombectomy (BOSTON SCIENTIFIC)

    5. PTA with a balloon
    - Armada 6 x 200 mm balloon (ABBOTT VASCULAR)

    6. Drug coated balloon therapy of the in-stent segment
    - In-Pact Admiral 6 x 150 mm balloon (MEDTRONIC)

    7. Stent placement in the proximal left SFA segment
    - Zilver PTX drug-eluting stent 6 x 120 mm (COOK MEDICAL)
    View image
  • - , Room 2 - Technical Forum

    Case 22 – Iliac vein compression

    Center:
    Singapore, Changi General Hospital
    Case 22 – CGH 04: male (S-K)
    Operators:
    • Steven Kum,
    • Tan Yih Kai,
    • Darryl Lim,
    • Derek Lim
    CLINICAL DATA
    Left and right leg swelling
    Previous spine instrumentation

    PROCEDURAL STEPS
    1. Bilateral SFV access under ultrasound
    - 5F Terumo sheath (TERUMO)
    - 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 (BARD)

    5. Iliac vein stenting
    - Sinus Obliquus 16 x 150 (OPTIMED)

    6. Postdilatation and IVUS control
    - 16/18 x 40 Atlas balloon (BARD)
    View image
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    Case 16 – AV fistula stenosis

    Center:
    Gwangju
    Case 16 – CNUH 03: male, 72 years
    Operators:
    • Jae Kyu Kim,
    • Nam Yeol Yim
    CLINICAL DATA
    ESRD s/p HD for 7 years
    Right radiocephalic AVF (7 years ago) had obstructed and HD through perm cath started
    Right brachiobasilic AVF creation (2016-11-7)

    RISK FACTORS
    Hypertension (30y ago)
    Diabetes (30y ago)
    US surveillance: Tight stenosis with decreased volume flow along venous limb of AVF (109 ml/min).
    Routine hemodialysis (3 times a week) through perm cath

    PROCEDURAL STEPS
    1. Retrograde puncture of AV fistula
    - 21 Gauge micro puncture kit (COOK)
    - 6F sheath (BOSTON SCIENTIFIC)

    2. PTA along venous limb of AVF with DEB
    - Lesion crossing with 0.035" hydrophilic guide wire (TERUMO) and 4F catheter (MERIT MEDICAL)
    - Vessel preparation with 5 mm – 40 mm high pressure balloon
    - 5 mm – 40 mm Lutonix DEB (BARD)
    View image
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    Case 17 – Chronic, calcified common iliac occlusion left

    Center:
    Leipzig, Dept. of Angiology
    Case 17 – LEI 06: male, 56 years (J-L)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    Severe claudication left leg, walking capacity 150 meters
    Failed recanalizaiton attempt left common iliac artery 2/2017
    Stenting right CIA 2/2017

    RISK FACTORS
    Art. Hypertension, nicotine abuse

    PROCEDURAL STEPS
    1. Left brachial approach
    - 6F 90 cm Check-Flo Performer (COOK)

    2. Left femoral approach
    - 7F 20 cm Radiofocus Introducer sheath (TERUMO)

    3. Guidewire passage
    - Stiff straight glidewire 260 cm (TERUMO) from both sides
    - CART-technique with 5.0/40 mm Admiral balloon (MEDTRONIC)

    4. Implantation of a covered stent
    - 8.0/38 mm LifeStream (BARD)
    View image
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    Case 18 – Subacute in-stent reocclusion left SFA

    Center:
    Leipzig, Dept. of Angiology
    Case 18 – LEI 07: male, 61 years (H-S)
    Operators:
    • Matthias Ulrich,
    • Andrej Schmidt
    CLINICAL DATA
    Severe claudication left calf, walking capacity 100 meters, since 2 months
    Stenting left SFA 2/2014
    CAD, PTCA 2012
    ABI left 0.64; right 0.81
    Duplex-sonography: total occlusion of stents left SFA

    RISK FACTORS
    Art. Hypertension, diabetes mellitus type II
    Former smoker
    Moderat renal insufficiency, GFR 55ml/min

    PROCEDURAL STEPS
    1. Right groin retrograde and cross-over approach
    - IMA diagnostic 5F catheter (CORDIS/CARDINAL HEALTH)
    - 0.035" angled soft Radiofocus glidewire, 190 cm (TERUMO)
    - 0.035" SupraCore guidewire, 190 cm (ABBOTT)
    - 8F Balkin Up&Over Sheath, 40 cm (COOK)

    2. Passage of the occlusion and percutaneous thrombectomy
    - 0.035" stiff angled glidewire 260 cm (TERUMO)
    - 0.035" QuickCross support catheter 135 cm (SPECTRANETICS)
    - Exchange to Rotarex guidewire (STRAUB MEDICAL)
    - 8F Rotarex thrombectomy catheter (STRAUB MEDICAL)

    3. PTA with DCBs
    - In.Pact Pacific 5.0/120 mm drug-coated balloons (MEDTRONIC)
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    Case 19 – Right SFA long occlusion

    Center:
    Gwangju
    Case 19 – CNUH 04: male, 75 years
    Operators:
    • Jae Kyu Kim,
    • Nam Yeol Yim
    CLINICAL DATA
    Severe claudication right leg, walking distance 50 meters

    RISK FACTORS
    Former smoker
    Laryngeal cancer under CTX procedural steps

    PROCEDURAL STEPS
    1. Access left groin and cross-over approach
    - 7F Ansel sheath 45 cm (COOK)

    2. Intraluminal Passage of the lesion with hydrophilic guide wire
    - 5F Headhunter diagnostic catheter (BOSTON SCIENTIFIC)
    - 0.035" Glidewire (TERUMO)
    - If necessary, 2.35" 90 cm CXI support catheter (COOK)
    - 0.014" 300 cm PT2 guidewire (BSC)

    3. Filter placement
    - 0.014" 300 cm Throughway/Commend ES guidewire (BOSTON SCIENTIFIC/ABBOTT)
    - 4/7 mm 200 cm Spider FX emboli protection device (eV3)

    4. Atherectomy and thrombectomy
    - 2.4/3.4 Jet stream Pathway rotational atherectomy

    5. PTA
    - LUTONIX drug coated balloon catheter (BARD) 6.0/150 mm

    6. Spot stenting if necessary
    - LIFE stent (BARD) 6.0 mm
    View image
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    Case 20 – Popliteal and BTK-CTO with CLI

    Center:
    Leipzig, Dept. of Angiology
    Case 20 – LEI 08: male, 64 years (V-S)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    CLI with restpain right foot, Rutherford class 4,
    TEA right groin 1/2016, stenting right SFA 2010
    PTA of a restenosis right SFA 2/2017

    RISK FACTORS
    Diabetes mellitus type 22, former smoker, art. Hypertension

    PRESENT STATE
    ABI right 0.32

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

    2. Guidewire passage of the popliteal and peroneal artery right
    - 0.018" Connect guidewire, 300 cm (ABBOTT)
    - 0.018" Seeker support catheter, 90 cm (BARD)

    3. In case of antegrade failure retrograde access via the peroneal artery
    - 7 cm 21 Gauge needle (COOK)
    - 0.018" Seeker support catheter (BARD)

    4. Atherectomy and PTA
    - HawkOne directional atherectomy (MEDTRONIC)
    - Armada 14 balloon (ABBOTT)
    - Pacific balloon (MEDTRONIC)

    5. Arterial wall injection of dexamethason
    - BullFrog Micro-Infusion-Device (MERCATOR MEDSYSTEMS)
    View image
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    Case 21 – Restpain left with popliteal reocclusion

    Center:
    Leipzig, Dept. of Angiology
    Case 21 – LEI 09: female, 78 years (M-V)
    Operators:
    • Matthias Ulrich,
    • Yvonne Bausback
    CLINICAL DATA
    Critical limb ischemia with restpain left foot, Rutherford class 4
    PTA left SFA and popliteal artery (DCBs) 5/2013
    PTA right SFA 2/2017
    CAD, PTCA 2015
    Renal insufficiency, GFR 55 ml/min

    RISK FACTORS
    Former nicotine abuse, art. Hypertension

    PRESENT STATE
    ABI left: 0.1

    PROCEDURAL STEPS
    1. Left antegrade approach
    - 6F 55 cm Check-Flo Performer (COOK)

    2. Guidewire passage
    - 0.018" Connect 250 T, 300 cm guidewire (ABBOTT)

    3. PTA
    - Armada 5.o/40 mm and 6.0/40 mm balloon (ABBOTT)

    4. Stenting
    - 5.0/60 mm Supera stent (ABBOTT)
    View image

Conference day 3

  • - , Room 1 - Main Arena

    Case 23 – EVAR + bilateral iliac branched devices

    Center:
    Beijing
    Case 23 – BPH 03: male, 68 years (X-D)
    Operators:
    • Wei Guo,
    • Zhang Hongpeng
    CLINICAL DATA
    Incidental finding of an abdominal aortic aneurysm with progression to 53 mm max. diameter

    RISK FACTORS
    Hypertension, CVD, smoker
    CTA: AAA 51 mm, aneurysm bilateral CIA

    PROCEDURAL STEPS
    1. Retrograde bilateral femoral and left brachial percutaneous access
    - Preloading of Proglide-Systems (ABBOTT) for both femoral access

    2. Implantation of the bifurcated stentgraft mainbody
    - Ankura stentgraft (LIFETECH SCIENTIFIC)

    3. Implantation of iliac branched devices
    - Ankura iliac branched devices (LIFETECH SCIENTIFIC)

    4. Implantation of covered stents into the IIA
    - Viabahn stentgraft (GORE)
    View image
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    Case 24 – Left radio-cephalic AV fistuloplasty

    Center:
    Singapore, Singapore General Hospital
    Case 24 – SGH 01: female, 56 years (NBI)
    Operators:
    • Farah Gillan Irani,
    • Sum Leong
    CLINICAL DATA
    Left RC AVF created April 2016.
    Aug 2016 underwent fistuloplasty of juxta-anastomotic segment and outflow cephalic vein at elbow using with 5mm POBA with good results.
    Also underwent coil embolization of competing draining collateral vein at same sitting.
    Currently: reducing transonic flow.

    RISK FACTORS
    ESRF (since 2015) secondary to diabetes & hypertension.
    Ischaemic heart disease. Failed peritoneal dialysis, now on haemodialysis.

    PRESENT STATE
    Reducing transonic flow. AVF duplex scan shows >75% recurrent stenosis at Juxta-anastomotic segment.

    PROCEDURAL STEPS
    1. Fistulogram via retrograde ultrasound guided 'V' cannulation site access

    2. Stenosis crossing using V18 wire supported by 4F Berenstein II catheter

    3. Angioplasty
    - 4 – 5 mm (POBA) angioplasty, if unable to efface lesion/suboptimal result, for cutting balloon angioplasty (5/20 mm)

    4. Definitive angioplasty with 5 – 6 mm drug coated balloon (DCB)

    5. In case of rupture, bail out covered stenting with 6/50 mm Viabahn
    View image
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    Case 25 – TEVAR and in-situ fenestration

    Center:
    Beijing
    Case 25 – BPH 04: male, 45 years (S-W)
    Operators:
    • Liu Xiaoping,
    • Xu Yongle
    CLINICAL DATA
    Acute Type-B dissection 2 weeks ago, since then intermittent back pain

    RISK FACTORS
    Hypertension, smoker
    CTA: Aortic dissection, Stanford type B
    Almost occluded right common iliac artery

    PROCEDURAL STEPS
    1. Retrograde left brachial and left femoral artery access
    - Preloading of Proglide-Systems left femoral artery (ABBOTT)

    2. Implantation of thoracic stentgraft
    - Ankura thoracic stentgraft (LIFETECH SCIENTIFIC)

    3. In-situ fenestration of thoracic stentgraft

    4. Stentgraft into the left subclavian artery
    - Viabahn stentgraft (GORE)

    5. Maybe stent of right common iliac artery
    - Complete SE (MEDTRONIC)
    View image
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    Case 28 – Extremely calcified SFA-occlusion

    Center:
    Leipzig, Dept. of Angiology
    Case 28 – LEI 10: male, 54 years (F-B)
    Operators:
    • Andrej Schmidt,
    • Johannes Schuster
    CLINICAL DATA
    Severe clauducation right, walking capacity 100 meters, Rutherford class 3
    PTA/stent left SFA 1/2017
    CAD, CABG 2006

    PRESENT STATE
    ABI right: 0.58
    Angiography during PTA left SFA: extremely calcified distal right SFA

    PROCEDURAL STEPS
    1. Right antegrade approach
    - 7F 55 cm Check-Flo Performer sheath (COOK)

    2. Guidewire passage of the SFA-CTO right
    - 0.035" Glidewire Advantage (TERUMO)
    - 0.035" CXC support catheter, 90 cm (COOK)

    In case of failure to pass the GW from antegarde
    3. Retrograde approach via the proximal ATA
    - 7 cm 21 Gauge needle (COOK)
    - 0.018" CXC support catheter, 90 cm (COOK)

    4. PTA
    - Pacific 5.0 and 6.0/40 mm balloon (MEDTRONIC)
    - VascuTrak 6/40 mm balloon (BARD)
    - Conquest high pressure balloon (BARD)

    In case of rupture or inability to brake the calcified plaque
    5.
    - Implantation of a Viabahn 7.0/100 mm (GORE) and
    - additional aggressive ballooning after Viabahn implantation

    6. Supera stent implantation
    - 6.0/150 mm Supera (ABBOTT)
    View image
  • - , Room 1 - Main Arena

    Case 29 – CLI right, BTK total occlusions

    Center:
    Leipzig, Dept. of Angiology
    Case 29 – LEI 11: male, 63 years (L-F)
    Operators:
    • Andrej Schmidt,
    • Yvonne Bausback
    CLINICAL DATA
    PAOD Rutherford 5, ulceration forefoot right
    Stenting of a SFA-occlusion right 11/2013
    Failure to pass the TPT-occlusions right from antegrade 11/2013
    ABI right 0.32
    CAD, CABG 10/2013

    RISK FACTORS
    Art. Hypertension, diabetes mellitus type 2

    PRESENT STATE
    ABI: mediasclerosis
    Angiography from previous unsuccessful intervention

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

    2. Retrograde puncture of the peroneal and/or posterior tibial artery
    - 21 Gauge / 7 cm needle (COOK)
    - 0.018" V-18 control guidewire, 300 cm (BOSTON SCIENTIFIC)
    - Trail Blazer support catheter, 90 cm (COVIDIEN)
    - Snaring of the retrograde GW to the antegrade sheath

    3. Atherectomy of the proximal tibial arteries (bifurcation)
    - Small vessel TurboHawk (MEDTRONIC)

    4. PTA of the tibioperoneal trunk and posterior tibial artery
    - Lutonix DCB (BARD)
    View image

Live case transmission centers

 

During LINC Asia-Pacific 2017 several live cases will be performed from several international centers. All live case transmissions are coordinated, filmed, and produced by the mediAVentures crew, using the latest in high definition television and wireless technology.

• Beijing PLA Hospital, Beijing, China with Wei Guo
• Changi General Hospital, Singapore with Steven Kum
• Singapore General Hospital, Singapore with Tay Kiang Hiong, Chong Tze Tec
• Chonnam National University Hospital, Gwangju, South Korea with Jae-Kyu Kim 
• Mount Sinai Hospital, New York, USA with Prakash Krishnan
• University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany with Andrej Schmidt, Matthias Ulrich, Johannes Schuster, Yvonne Bausback