LINC Asia-Pacific 2017 live case guide

Find all live cases and live case centers listed below.

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
  • - , Room 1 - Main Arena

    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 26 – Left SFA and anterior tibial CTOs

    Center:
    Singapore, Singapore General Hospital
    Case 26 – SGH 02: female, 60 years (CYC)
    Operators:
    • Kiang Hiong Tay,
    • Farah Gillan Irani
    CLINICAL DATA
    Left calf claudication for several months, recently rest pain
    No tissue loss

    PRESENT STATE
    Non Smoker
    Diabetes mellitus, hypertension, hyperlipidaemia
    Toe pressures: R 60 mmHg, L 50 mmHg
    Duplex scan showed SFA and ATA CTOs

    PROCEDURAL STEPS
    1. Downhill puncture
    - 5F Britetip short sheath

    2. Intra luminal crossing of SFA CTO
    - In case of failure subintimal crossing will be performed.
    If wire fails to reenter true lumen, retrograde crossing will be attempted via popliteal artery puncture.

    3. Angioplasty
    - Passeo Lux drug coated balloons. Spot stenting if necessary with Pulsar 18 stent.

    4. Balloon assisted haemostasis for popliteal puncture site (if any)

    5. Exchange for long 35 cm sheath

    6. Intra luminal crossing of ATA CTO
    - V18 wire
    - In case of failure subintimal crossing will be performed.
    If wire fails to reenter true lumen, retrograde crossing will be attempted via distal ATA puncture.

    7. Angioplasty
    - Passeo Lux drug coated balloons

    8. Balloon assisted haemostasis for ATA puncture site (if any)

    9. Groin hemostasis with manual compression
    View image
  • - , Room 1 - Main Arena

    Case 27 – Right SFA critical stenosis and distal disease

    Center:
    Singapore, Singapore General Hospital
    Case 27 – SGH 03: male, 64 years (HCS)
    Operators:
    • Tze Tec Chong,
    • Edward Choke
    CLINICAL DATA
    Patient with severe claudication and rest pain, no tissue loss

    RISK FACTORS
    Hyperlipidemia, hypertension, peripheral artery disease

    PROCEDURAL STEPS
    1. Access considerations given axillobifemoral graft

    2. Crossing of SFA lesion

    3. Consideration for arthrectomy

    4. Deployment of distal embolic protection device

    5. Drug eluting balloon and balloon angioplasty

    6. Consideration for DES

    7. Evaluation of tibial disease

    8. Tibial angioplasty

    9. DEB tibial

    10. Hemostasis – suture
    View image
  • - , Room 1 - Main Arena

    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
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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

 

 

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