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)

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)

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

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

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)

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)

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)

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)

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)

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)

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)

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

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)

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

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)

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)

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)

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)

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)

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

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)

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)

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)

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

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)

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

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

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)

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)