Conference day 3

• 8:14 - 8:46, 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)

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• 9:58 - 10:23, Room 1 - Main Arena

  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

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• 10:44 - 11:23, 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)

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• 13:30 - 16:00, Room 1 - Main Arena

  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

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• 13:30 - 16:00, 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

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• 13:30 - 16:00, 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)

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• 15:30 - 16:00, 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)

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