Case 01 – Total occlusion left common iliac artery
Center:
University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
Case 01 – LEI 01: male, 63 years, (S-F)
Operators:
Andrej Schmidt,
Matthias Ulrich
CLINICAL DATA
Severe claudication left buttock, thigh and calf, walking capacity 50 meters
Rutherford class 3
CAD with PTCA 2008 and 2015
Former smoker
Art. Hypertension
ANGIOGRAPHY
During PTCA 2015: calcified total occlusion left common iliac artery
ABI left 0.65
PROCEDURAL STEPS 1. Femoral access left side
- 7F 25 cm sheath (TERUMO)
Left brachial approach:
- 7F 90 cm Check-Flo Perfomer Sheath (COOK)
2. Guidewire passage from brachial
- 5F 125 cm Judkins Right diagnostic catheter (CARDINAL HEALTH)
- 0.035" stiff angled glidewire, 260 cm (TERUMO)
3. Guidewire passage from femoral
- 5F 80 cm Multipurpose diagnostic catheter (CARDINAL HEALTH)
- 0.035" stiff angled glidewire, 260 cm (TERUMO)
- Potentially double-balloon-technique with:Admiral balloon 5.0/40 mm, 135 cm (MEDTRONIC)
PROCEDURAL STEPS 1. Left groin access and cross-over approach
- 5F IMA-cathter (CARDINAL HEALTH)
- 0.035" soft angled glidewire 180 cm (TERUMO)
- 0.035" SupraCore Guidewire 180 cm (ABBOTT)
- 6F 40 cm Balkin Up&Over Sheath (COOK)
2. Guidewire passage
- 0.018" Connect guidewire, 300 cm (ABBOTT)
- 4.0/120 mm Pacific Extreme balloon catheter, 135 cm (MEDTRONIC)
- In case of thrombus Rotarex thrombectomy before PTA (STRAUB MEDICAL)
3. PTA with drug-coated balloons
- 5.0/120 mm In.Pact Pacific (MEDTRONIC)
4. Stenting on indication
- Complete selfexpanding nitinol-stent (MEDTRONIC)
University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
Case 03 – LEI 03: male, 64 years (W-S)
Operators:
Andrej Schmidt,
Yvonne Bausback
CLINICAL DATA
Severe claudication both calves, walking capacity 150 meters; right > left
Rutherford classification 3
Mitral insufficiency II, NYHA II
Art. hypertension, former smoker
COPD
ABI right 0.66; left 0.67
PROCEDURAL STEPS 1. Left groin access and cross-over approach
- 5F IMA-cathter (CARDINAL HEALTH)
- 0.035" soft angled glidewire 180 cm (TERUMO)
- 0.035" SupraCore guidewire 180 cm (ABBOTT)
- 6F 40 cm Balkin Up&Over Sheath (COOK)
2. Gudewire passage
- 0.035" stiff angled glidewire, 260 cm (TERUMO)
- Seeker support catheter, 135 cm (BARD)
- Exchange to a 0.018" SteelCore guidewire, 300 cm (ABBOTT)
3. PTA
- VascuTrak balloon 5.0/250 mm (BARD)
- Lutonix DCB 5.0 or 6.0/150 mm (BARD)
4. Stenting on indication
- LifeStent selfexpanding nitinol-stent (BARD)
University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
Case 05 – LEI 04: female, 63 years (S-G)
Operators:
Andrej Schmidt,
Matthias Ulrich
CLINICAL DATA
Severe claudication right SFA, walking capacity 100 meters
PTA left SFA 2/2016
PTA right SFA 2014 elsewhere
CEA right internal carotid artery 2012
Art. hypertension
Diabetes mellitus type 2
ANGIOGRAPHY
Right SFA during PTA left SFA 2/2016
ABI right 0.65
PROCEDURAL STEPS 1. Left groin access and cross-over approach
- 5F IMA cathter (CARDINAL HEALTH)
- 0.035" soft angled glidewire 180 cm (TERUMO)
- 0.035" SupraCore guidewire 300 cm (ABBOTT)
- 6F 40 cm Balkin Up&Over Sheath (COOK)
2. Gudewire passage
- 0.035" stiff angled glidewire, 260 cm (TERUMO)
- CXC support catheter, 135 cm (COOK)
- Exchange to a 0.035" SupraCore guidewire, 300 cm (ABBOTT)
3. PTA and stenting
- Advance 0.035" balloon 5.0/100 mm (COOK)
- Zilver-PTX stents 6.0/120 mm (COOK)
Case 06 – LEI 05: Re-occlusion left, partially in-stent
Center:
University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
Case 06 – LEI 05: male, 58 years (G-N)
Operators:
Andrej Schmidt,
Sven Bräunlich
CLINICAL DATA
Severe claudication left calf, walking capacity 100 meters, restpain during night
Rutherford class 4
Failed antegrade recanalization attempt left SFA 2/2016
PTA and stenting left SFA elsewhere 1/2015
CAD, COPD, art. hypertension, former smoker
ABI left 0.55
PROCEDURAL STEPS 1. Right groin access and cross-over approach
- 5F IMA-cathter (CARDINAL HEALTH)
- 0.035" soft angled glidewire 180 cm (TERUMO)
- 0.035" SupraCore guidewire 180 cm (ABBOTT)
- 7F 40 cm Balkin Up&Over Sheath (COOK)
2. Guidewire passage
- 0.035" stiff angled glidewire, 260 cm (TERUMO)
- QuickCross support catheter, 135 cm (SPECTRANETICS)
- Exchange to a 0.014" Floppy ES Extrasupport guidewire, 300 cm (ABBOTT)
3. In case of failure to pass the guidewire from antegrade
Stent-puncture (proximal or disal stent):
- 18 gauge 7 cm needle proximal and 21 gauge 9 cm needle distally (COOK)
- 0.018" V-18 Control guidewire 300 cm (BOSTON SCIENTIFIC)
- 0.018" QuickCross support catheter 90 cm (SPECTRANETICS)
4. Laser atherectomy and PTA
- 7F Tandem Booster-Laser atherectomy (SPECTRANETICS)
- Stellarex DCB 5.0/120 mm (SPECTRANTICS)
Case 08 – LEI 06: Severely calcified popliteal occlusion right
Center:
University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
Case 08 – LEI 06: male, 62 years (KH-L)
Operators:
Sven Bräunlich,
Andrej Schmidt
CLINICAL DATA
Critical limb ischemia with ulceration dig V
Rutherford class 5
CAD, ischemic cardiomyopathy, EF 45%, NYHA II
Diabetes mellitus type 2, former smoker
ANGIOGRAPHY
Distal SFA / Apop P1-segment occlusion right
Anterior and posterior tibial artery occlusion
Severe calcification
ABI right 0.33
PROCEDURAL STEPS 1. Right antegrade access
- 6F 55 cm sheath (COOK)
2. Guidewire passage
- 0.035" stiff angled glidewire, 260 cm (TERUMO)
supported by a balloon:
- Armada 35 balloon 4.0/80 mm, 90 cm (ABBOTT)
in case of failure to pass the CTO from antegrade retrograde approach via peroneal artery:
- 7 cm 21 gauge needle (COOK)
- 0.018" Connect guidewire 300 cm (ABBOTT)
- 0.018" QuickCross support catheter (SPECTRANETICS)
3. PTA and stenting
- Armada 5.0 or 6.0/40 mm (ABBOTT)
- 5.0 Supera Interwoven nitinol-stent (ABBOTT)
Case 09 – LEI 07: Anterior tibial artery occlusion, multiple ulcerations forefoot left
Center:
University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
Case 09 – LEI 07: male, 65 years (H-G)
Operators:
Matthias Ulrich,
Yvonne Bausback
CLINICAL DATA
Ulceration Left foot, Rutherford class 5
Failed antegrade recanalization attempt with failure to pass the guidewire through the ATA-CTO elsewhere
Diabetes mellitus type 2, art. hypertension, former smoker
ANGIO
ABI right 0.44
Anterior tibial artery occlusion left, high offspring
PROCEDURAL STEPS 1. Antegrade access left
- 6F 55 cm sheath (COOK)
2. Retrograde approach via the dorsalis pedis artery left
- Pedal puncture set (COOK)
- 4 cm 21 gauge needle (COOK)
- 2.9F sheath (COOK)
- 0.018" V-18 Control guidewire 300 cm (BOSTON SCIENTIFIC)
- 0.018" CXI support catheter 90 cm (COOK)
- Exchange to 0.014" Hydro-ST guidewire 300 cm (COOK)
- Advance Micro balloon 3.0/120 mm, 90 cm (COOK)
3. PTA from antegrade with DCBs
After predilatation from retrograde
- Lutonix DCBs from antegrade (BARD)
Case 10 – LEI 08: Progressive, highgrade stenosis left internal carotid artery
Center:
University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
Case 10 – LEI 08: male, 72 years (R-F)
Operators:
Andrej Schmidt,
Sven Bräunlich
CLINICAL DATA
90% stenosis left ICA
Minor stroke 1/2015
Art. hypertension, diabetes mellitus type 2
CAD with NSTEMI 11/2015, PTCA
RISK FACTORS
Left ICA flow-velocity progression
1/2015: 2.5m/sec
11/2015: 4.8m/sec
Angiography during PTCA 11/2015: 90% stenosis left ICA
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)
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