LINC Middle East 2016 live case guide

Rashid Hospital, Dubai, United Arab Emirates

• Thursday, April 7th: 10:57 - 11:22, Main Arena

  Case 04 – Endovascular repair of left CFA and SFA occlusion

  Center:

  Rashid Hospital, Dubai, United Arab Emirates

  Case 04 – RAH 01: male, 61 years (I-A)

  Operators:

  • Ayman Al-Sibaie,
  • A. Alfalahi

  CLINICAL DATA
  PAD with intermittent claudication, left leg pain
  Rutherford grade I Fontain IIB.
  ABI = 0.3
  
  IMPORTANT ITEMS
  HTN, IHD, Angioplasty and stenting done for both external iliac arteries and surgical procedure profundaplasty was done in 2012.
  
  PROCEDURAL STEPS
  1. Access right groin and cross-over approach
  - 7F Flexor Check-flo introducer (COOK)
  
  2. Recanalization of left common femoral artery
  - TERUMO 0.035" with support catheter 4 Fr. glide catheter (TERUMO)
  
  3. Predilation
  - 5.0 x 60 mm ballon catheter
  
  4. Postdilatation
  - DEB 0.035" 6.0 mm x 80 mm 130 cm In.pact Admiral (MEDTRONIC)
  
  5. Retrograde access to recanalize superficial femoral artery
  
  6. PTA with DEB depends on final angiography
  
  7. Spot stenting in case of dissection or residual stenosis
  - Depending on the location either SUPERA or Zilver PTX (COOK)

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• Thursday, April 7th: 14:31 - 14:51, Main Arena

  Case 07 – RAH 02: Right lower limb below knee triple artery segmental stenosis

  Center:

  Rashid Hospital, Dubai, United Arab Emirates

  Case 07 – RAH 02: male, 53 years (N-G)

  Operators:

  • Ayman Al-Sibaie,
  • A. Alfalahi

  CLINICAL DATA
  Right leg pain, rutherford grade III Fontain IV.
  Right SFA total occlusion balloned and stented.
  RT ABI = 0.2
  
  IMPORTANT ITEMS
  HTN, DM type II, IHD, CCF
  
  PROCEDURAL STEPS
  1. Right femoral antegrade access
  
  2. Antegrade recanaliztion of anterior and posterior tibial arteries, in cases not successful retrograde access will be used
  
  3. Retrograde pedal access
  - Micro puncture set (COOK)
  
  4. Recanalization
  - 0.014" wire command ABBOTT with support catheter
  
  5. Snaring of the wire through the femoral access
  
  6. Ballon angioplasty
  - Over the wire in antegrade direction ballon angioplasty 2.5 mm dilator 0.014" Armada ABBOTT

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• Friday, April 8th: 9:01 - 9:26, Main Arena

  Case 12 – RAH 03: AAA with extension to common iliac arteries modified implantation technique of IBD

  Center:

  Rashid Hospital, Dubai, United Arab Emirates

  Case 12 – RAH 03: male, 55 years (M-A)

  Operators:

  • Ayman Al-Sibaie,
  • A. Alfalahi

  CLINICAL DATA
  Infrarenal AAA measuring 5.7 cm extending over the aortic bifurcation to common iliac arteries
  
  RISK FACTORS
  -Short common iliac arteries, the internal iliac artery bilaterally are seen originating approx. 1 cm distal to the orgin of common iliac arteries.
  -Standard devices can't provide long term distal sealing.
  -Modified implantation technique of IBD is required as the right common iliac artery is too short to do it according to IFU.
  
  PROCEDURAL STEPS
  MAIN BODY (ZENITH COOK) insertion through left femoral access
  
  2. Through and through wire from left brachial access through the main body to right femoral access
  
  3. Insertion IBD (ZENITH COOK) through the right femoral access using the through and through wire as an access to the Internal iliac artery branch
  
  4. Periphral stent graft 7F BENTLEY InnoMED will be inserted through the left brachial access through the IBD into right internal iliac artery
  
  5. Connecting IBD with main body
  
  6. Extending left iliac limb into the external iliac artery covering the left internal iliac artery

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