LINC Asia-Pacific 2015 Live Case Guide

Find all Live Cases and Live Case Centers listed below.

Conference day 1

  • - , Main Arena

    Case 01 – Right popliteal occlusion

    Center:
    Changi General Hospital, Singapore
    Case 01 – CGH 01: male, 64 years (J-N-C)
    Operators:
    • Steven Kum,
    • Tan Yih Kai,
    • Sven Bräunlich,
    • Tjun Tang
    CLINICAL DATA
    PAOD Rutherford 3
    DM Hypertension Graves Disease
    AF EF 60% Cr normal

    PROCEDURAL STEPS
    1. Antegrade access via right groin
    - 6F sheath (TERUMO)

    2. Passage of the lesion with hydrophilic wire
    - 0.018" V-18 control wire, 300 cm (BOSTON SCIENTIFIC)
    - 4F Ber II catheter (CORDIS)

    3. Retrograde ATA access in event of antegrade failure
    - 4F Micropuncture® Pedal Access Set (COOK)
    - 0.018" V-18 control wire, 300 cm (BOSTON SCIENTIFIC)
    - 2.6F CXI support catheter, 90 cm (COOK)

    4. Predilatation and lesion preparation
    - 3.5 x 120 Chocolate balloon (QT VASCULAR)

    5. PTA with DEB
    - In.Pact Pacific 4 or 5 x 120 mm DEB-balloon (MEDTRONIC)

    6. Stenting on indication
    View image
  • - , Main Arena

    Case 02 – DEB for SFA/PopA stenosis

    Center:
    Chang Gung Memorial Hospital, Taoyuan City, Taiwan
    Case 02 – TAO 01: female, 80 years (H-M-L)
    Operators:
    • I-Hao Su,
    • Sung-Yu Chu
    CLINICAL DATA
    Rutherford 5, chronic minor wound at left big toe
    DM type 2, HTN, hepatitis C
    Bilateral PAD s/p right femoral-popliteal graft bypass
    s/p left knee replacement
    EF: 76%, Cr 0.79

    CTA
    Skipped focal mild-severe stenosis in the LSFA
    Focal skipped mild stenosis in the P3 portion of LPopA
    Short CTO in the proximal LATA
    and skipped focal high grade stenosis

    DUPLEX
    ABI: right 0.57, left 0.55
    Lt. distal CFA bifurcation mod stenosis; 
and lt. femoropopliteal difuse stenosis 
and multiple significant lesions; 
bil severe infrapopliteal diseased 
with multiple severe stenosis 
and segemental occcluded lesions at bil ATA amd PTA

    PROCEDURAL STEPS
    1. Retrograde access (ultrasound guided puncture) via RCFA
    - 5F Tempo Flush pigtail catheter (CORDIS)
    - 0.035" Radiofocus Terumo Angled Stiff guidewire (TERUMO)
    - 6F Balkin cross over sheath (COOK)

    2. Passage of the lesion with hydrophilic wire to TP
    - 0.018" V18 control wire, 300 cm (BOSTON SCIENTIFIC)

    3. Predilatation and PTA with DEB for SFA/PopA
    - Pacific Xtreme 4/40 (MEDTRONIC)
    - In-Pact Pacific DEB balloon 5/6 mm (MEDTRONIC)

    4. PTA for BTK
    - 0.018" V18 control wire, 300 cm (BOSTON SCIENTIFIC)
    - Amphirion 2/2.5/3 (MEDTRONIC)
    View image
  • - , Main Arena

    Case 03 – Right SFA occlusion

    Center:
    Changi General Hospital, Singapore
    Case 03 – CGH 02: female, 65 years (R?)
    Operators:
    • Steven Kum,
    • Tan Yih Kai,
    • Sven Bräunlich
    CLINICAL DATA
    PAOD Rutherford 3
    DM hypertension hyperlipidemia EF 60% Cr 140

    PROCEDURAL STEPS
    1. Contralateral cross-over access via left groin
    - 0.035" Radiofocus Terumo angled soft guidewire, 260 cm (TERUMO)
    - 4F Ber II catheter (CORDIS)
    - 0.035" Supra Core guidewire, 300 cm (ABBOTT)
    - 6F 40 cm long Balkin sheath (COOK)

    2. Passage of the lesion with hydrophilic wire and predilatation
    - 0.018" V-18 Control Wire, 300 cm (BOSTON SCIENTIFIC)
    - 0.035" Radiofocus Terumo angled soft guidewire, 250 cm (TERUMO)
    - 4F Ber II catheter (CORDIS)
    - 0.018" Trailblazer support catheter (COVIDIEN)

    3. Vessel preparation
    - 4 or 5 x 120 mm 3.5 x 120 Chocolate balloon (QT VASCULAR)

    4. Treatment with DEB
    - In.Pact Pacific 5/6 x 120 mm DEB-balloon (MEDTRONIC)

    5. Stenting on indication
    - Spot-stenting with a COMPLETE SE stent (MEDTRONIC)
    View image
  • - , Main Arena

    Case 04 – DEB for ISR in hemodialysis access

    Center:
    Chang Gung Memorial Hospital, Taoyuan City, Taiwan
    Case 04 – TAO 02: male, 85 years (T-H-Y)
    Operators:
    • Ta-We Su,
    • Sung-Yu Chu
    CLINICAL DATA
    ESRD under regular hemodialysis, hearing impairment, EF 71%
    Left radio-graft-basilic fistula s/p Viabahn (6/150 mm)
    for venous anastomosis junction

    RISK FACTORS
    Increased venous pressure during hemodialysis

    VENOGRAPHY
    Two skipped focal instent stenosis (about 30-50% stenosis)
    and short segmental 70% stenosis in the distal edge of Viabahn

    PROCEDURAL STEPS
    1. Antegrade puncture via proximal graft
    - 6F sheath (TERUMO)

    2. Angiography to estimate lesions

    3. PTA with DEB for instent restenosis
    - InPact Admiral DEB balloon 6/120 mm (MEDTRONIC)
    View image
  • - , Overflow

    Case 11 – May Thurner syndrome

    Center:
    Changi General Hospital, Singapore
    Case 11 – CGH 04: female (R)
    Operators:
    • Tan Yih Kai,
    • Steven Kum,
    • Sven Bräunlich,
    • Tjun Tang
    CLINICAL DATA
    Left leg swelling previous DVT right Ca Breast
    CT venogram done
    Diagnostic angio and IVUS done

    PROCEDURAL STEPS
    1. General anaesthesia

    2. Left mid SFV access under ultrasound
    - 5F sheath (TERUMO)
    - 12F Peel-away Safe-sheath (ANGIODYNAMICS)

    3. Passage of the lesion with hydrophilic wire and stiff wire
    - 0.035" Radiofocus angled soft guidewire, 260 cm (TERUMO)
    - 4F Ber II catheter (CORDIS)
    - 0.035" Supra Core guidewire, 300 cm (ABBOTT)

    4. Venogram and IVUS
    - 8.5F Visions® PV.035 (VOLCANO)

    5. Predilatation
    - 12 x 40 Mustang balloon (BOSTON SCIENTIFIC)
    - 16/18 x 40 Atlas balloon (BARD)

    6. Iliac vein stenting
    - Wallstent 18 x 90 (BOSTON SCIENTIFIC)

    7. Postdilatation
    - 16/18 x 40 Atlas balloon (BARD)

    8. Postimplantation IVUS and sealing of puncture site
    View image
  • - , Main Arena

    Case 05 – High grade progressive stenosis right ICA

    Center:
    University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
    Case 05 – LEI 01: female, 60 years (C-K)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    Progressive, asymptomatic stenosis right ICA
    PAOD, claudication both calfs

    RISK FACTORS
    Art. hypertension
    Diabetes mellitus
    Former smoker

    DUPLEX
    3.8m/sec.
    Cranial CT without pathological findings

    ANGIOGRAPHY
    Calcified, 80% stenosis right ICA

    PROCEDURAL STEPS
    1. 9F-sheath right groin
    - 9F 25 cm (TERUMO)

    2. Cannulation of the external carotid artery right
    - 5F diagnostic Right Judkins catheter (CORDIS)
    - 0.035" angled soft glidewire (TERUMO)

    3. Exchange to a stiff guidewire and positioning of the protection device
    - 0.035" SupraCore 300 cm (ABBOTT)
    - 9F MOMA-system (MEDTRONIC)
    - Endovascular clamping of the external and common carotid artery

    4. Cannulation of the stenosis and predilatation
    - 0.014" Galeo Pro ES, 175 cm (BIOTRONIK)
    - 3.5/20 mm MiniTrek RX-balloon (ABBOTT)

    5. Implantation of a stent and postdilatation
    - Cristallo Ideale 7-10/30 mm (MEDTRONIC)
    - 5.0/20 mm Submarine Rapido balloon (MEDTRONIC)

    6. Aspiration of potential debris and declamping
    View image
  • - , Main Arena

    Case 06 – Occlusion mid SFA right

    Center:
    University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
    Case 06 – LEI 02: male, 69 years (D-M)
    Operators:
    • Andrej Schmidt,
    • Sabine Steiner
    CLINICAL DATA
    Chronic ulcerations both calfs / feet
    PTA left SFA Feb. 2015
    CAD with PTCA 2010

    RISK FACTORS
    Diabets mellitus, type 2
    Art. hypertension

    ANGIOGRAPHY
    During PTA left leg: SFA-occlusion right

    ABI RIGHT
    Pressure not tolerated due to ulceration

    PROCEDURAL STEPS
    1. Access left groin and cross-over approach
    - 5F IMA diagnostic catheter (CORDIS)
    - 0.035" angled soft glidewire (TERUMO)

    2. Passage of the occlusion right SFA and predilatation
    - 0.018" Cruiser S 300 cm guidewire (BIOTRONIK)
    - 5.0/120 mm Passeo 18 balloon (BIOTRONIK)

    3. PTA with drug-releasing balloon
    - Passeo-18 LUX 5/120 mm (BIOTRONIK)

    4. Stenting on indication
    - Pulsar 18 selfexpanding stent (BIOTRONIK)
    View image
  • - , Main Arena

    Case 07 – Left SFA occlusion

    Center:
    Changi General Hospital, Singapore
    Case 07 – CGH 03: male, 83 years (C-S-L)
    Operators:
    • Sven Bräunlich,
    • Steven Kum,
    • Tan Yih Kai
    CLINICAL DATA
    PAOD Rutherford 3
    COPD hypertension hyperlipidemia IHD EF 60% CKD Cr 200

    PRESENT STATE
    Left hip replacement Ca prostate CO2 angiography done

    PROCEDURAL STEPS
    1. Antegrade access via left groin
    - 5F sheath (TERUMO)
    - CO2 angiography with CO2 angioset (OPTIMED)

    2. Passage of the lesion with hydrophilic wire
    - 0.018" V-18 control wire, 300 cm (BOSTON SCIENTIFIC)
    - 4F Ber II catheter (CORDIS)

    3. Retrograde distal SFA access in event of antegrade failure
    - Supine frog leg position
    - 0.018" V-18 control wire, 300 cm (BOSTON SCIENTIFIC)
    - 2.6F CXI support catheter, 90 cm (COOK)

    4. Predilatation and lesion preparation
    - Paseo 18 4/5 x 120 balloon (BIOTRONIK)

    5. PTA with DEB
    - Lux 5 x 120 mm DEB-balloon (BIOTRONIK)

    6. Postdilatation and stenting on indication
    - REEF 5 x 40 high pressure balloon (MEDTRONIC)
    - 4F Pulsar 18 stent (BIOTRONIK)
    View image
  • - , Main Arena

    Case 08 – Long, chronic SFA-occlusion right

    Center:
    University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
    Case 08 – LEI 03: male, 62 years (W-T)
    Operators:
    • Matthias Ulrich,
    • Andrej Schmidt
    CLINICAL DATA
    Severe bilateral claudication intermittens
    Walking capacity 150 meters
    Failed recanalization attempt right SFA Feb. 2015
    CAD, PTCA 2012

    RISK FACTORS
    Diabetes mellitus type 2
    Art. hypertension
    Former smoker

    ANGIOGRAPHY
    bilateral long SFA-occlusions

    ABI
    Right 0.54; left 0.60

    PROCEDURAL STEPS
    1. Access left groin and cross-over access
    - 5F IMA-catheter (CORDIS)
    - 0.035" SupraCore guidewire 200 cm (ABBOTT)
    - 6F 40 cm Balkin Up&Over sheath (COOK)

    2. Passage of the occlusion
    Second antegrade attempt:
    - 0.035" CXI Support-Catheter 135 cm (COOK)
    - 0.035" stiff angled glidewire, 300 cm (TERUMO)

    In case of failure to pass from antegrade:
    3. Retrograde puncture of the distal SFA
    - 21 Gauge 9 cm puncture-needle (COOK)
    - 0.018" V-18 Control guidewire 300 cm (BOSTON SCIENTIFIC)
    - 0.018" CXI support catheter 90 cm (COOK)
    - Snaring of the retrograde guidewire from above

    4. PTA and stenting
    - 5/100 Advance 18 balloon (COOK)
    - Zilver-PTX drug-eluting stent (COOK)
    View image
  • - , Main Arena

    Case 09 – Occlusion of all BTK-arteries left

    Center:
    University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
    Case 09 – LEI 04: female, 78 years (T-T)
    Operators:
    • Andrej Schmidt,
    • Johannes Schuster
    CLINICAL DATA
    Restpain left foot, Rutherford class 4
    PTA / stent left SFA 2011,
    PTA of a restenosis left SFA Feb 2015,
    Failure to recanalize the ATA from antegrade Feb 2015
    CAD with CABG and PTCA 1999

    RISK FACTORS
    Diabetes mellitus type 2
    Art. hypertension

    ABI
    Left 0.4

    PROCEDURAL STEPS
    1. Antegrade access left groin
    - 5F 55 cm Ansel sheath (COOK)

    2. Retrograde approach via the distal ATA
    - Micro-puncture set (COOK)
    . - 3F micropuncture sheath
    . - 4 cm 21 Gauge needle
    - 0.018" Connect guidewire 300 cm (ABBOTT)

    3. Retrograde guidewire passage and PTA
    - 0.014" Hydro-ST guidewire 300 cm (COOK)
    - 2.5/120 mm Advance Micro balloon, 90 cm (COOK)
    View image
  • - , Main Arena

    Case 10 – Total occlusion all BTK-arteries right, CLI

    Center:
    University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
    Case 10 – LEI 05: male, 71 years (D-F)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    Restpain right foot,
    Bypass fem-pop nd PTA iliac arteries right 1/2014
    Failed recanalization attempt BTK right Feb 2015
    Chronic venous insufficiency

    RISK FACTORS
    Diabetes mellitus type 2
    Art. hypertension

    ANGIOGRAPHY
    During recanalization attempt right Feb. 2015:
    Bypass patent, all 3 BTK-arteries occluded

    PROCEDURAL STEPS
    1. Antegrade access right
    - 5F 55 cm Ansel-sheath (COOK)

    2. Retrograde access via the distal peroneal artery
    - 7 cm 21 Gauge needle (COOK)
    - 0.018" Connect guidewire 300 cm (ABBOTT)
    - 0.018" Seeker-support catheter 90 cm (BARD)

    3. Snaring of the retrograde guidewire from antegrade and antegrade PTA
    - 2.0 120 mm Pacific balloon (MEDRONIC)
    - 3.0/150 Lutonix DCB (BARD)
    View image

Conference day 2

  • - , Main Arena

    Case 12 – Left ATA occlusion

    Center:
    Changi General Hospital, Singapore
    Case 12 – CGH 05: male, 58 years (K-S-O)
    Operators:
    • Steven Kum,
    • Tan Yih Kai,
    • Sven Bräunlich
    CLINICAL DATA
    CLI left 2nd toe gangrene
    PAOD Rutherford 5
    DM hypertension hyperlipidemia Cr 116

    PROCEDURAL STEPS
    1. Antegrade access via left groin
    - 5F sheath (TERUMO)

    2. Antegrade passage of the lesion with hydrophilic wire
    - 0.014" COMMAND Extra support wire 300 cm (ABBOTT)
    - 2 x 80 Armada 14 (ABBOTT)

    3. Retrograde passage of lesion via ultrasound guided DP puncture
    - 4F Micropuncture® transpedal set (COOK)
    - EDGE ultrasound high frequency probe (SONOSITE)
    - 0.018" V-18 control wire, 300 cm (BOSTON SCIENTIFIC)
    - 2.6F Angled CXI support catheter, 90 cm (COOK)

    4. Predilatation and lesion preparation
    - 2.5 x 100 mm Vascutrak scoring PTA catheter (BARD)

    5. PTA with DEB
    - 2.5 or 3 x 120 mm Lutonix drug-coated balloon (BARD)
    View image
  • - , Main Arena

    Case 13 – Occlusion of left popliteal and tibial arteries

    Center:
    Beijing Military Hospital 301, Beijing, China
    Case 13 – BMH 01: male, 72 years
    Operators:
    • Wei Guo,
    • Xin Jia
    CLINICAL DATA
    PAOD Rutherford 4
    Rest pain at left foot
    Smoking for 30 years
    Coronary artery disease
    ABI left 0.5; right 0.7

    PROCEDURAL STEPS
    1. Antegrade access and placement of a long sheath
    - 0.035" Radiofocus Terumo angled soft guidewire, 180 cm (TERUMO)
    - 6F Flexor Straight sheath, 55 cm (COOK)

    2. Passage of the lesion with hydrophilic wire and predilatation
    - 0.018" V-18 control wire, 300 cm (BOSTON SCIENTIFIC)
    - 4/120 mm Pacific balloon dilatation catheter for POP, 130 cm (MEDTRONIC)
    - 2/120 mm DEEP balloon dilatation catheter for PA and PT, 130 cm (MEDTRONIC)

    3. Retrograde AT or PA puncture in case of antegrade failure
    - 0.018" V-18 control wire, 300 cm (BOSTON SCIENTIFIC)
    - 2/80 mm DEEP balloon dilatation catheter, 130 cm (MEDTRONIC)
    View image
  • - , Main Arena

    Case 14 – PEVAR plus distal sandwich technique for infra-renal AAA with RCIA aneurysm

    Center:
    Chang Gung Memorial Hospital, Taoyuan City, Taiwan
    Case 14 – TAO 03: male, 76 years (K-H-C)
    Operators:
    • Kuo-Sheng Liu,
    • Sung-Yu Chu
    CLINICAL DATA
    Herniated interveterbral disc with right leg numbness
    Infra-renal AAA was incidentally found by CT
    Hypertension, previous smoker, gout
    Cr 1.32, EF: 70%

    CTA
    Infrarenal AAA (5.8 x 5.6 cm, od) and RCIA aneurysm (3.9 cm/id) with much mural thrombus

    PROCEDURAL STEPS
    1. Retrograde access (ultrasound guided puncture) via RCFA and LCFA
    - Preclose techniques: Proglide (ABBOTT)
    - 8F and 10F sheaths for RCFA and LCFA (TERUMO)

    2. Angiography of AAA
    - 5F Tempo Flush pigtail catheter (CORDIS)
    - 0.035" Radiofocus Terumo Angled soft guidewire (TERUMO)
    - 0.038" Amplatz Stiff wire, 260 cm (BOSTON SCIENTIFIC)
    - 5F sizing catheter (MERIT)

    3. Deployment of AAA stent graft
    - Endurant: mainbody left side up, contralateral limb: right side (METRONICS)
    - 5F VanSchie catheter (COOK)
    - 0.035" Radiofocus Terumo Angled soft guidewire (TERUMO)
    - 0.038" Amplatz Stiff wire, 260 cm (BOSTON SCIENTIFIC)

    4. Post dilatation

    5. Retrograde access (ultrasound guided puncture) via left brachial artery
    - 5F Tempo Flush pigtail catheter (CORDIS)
    - 0.035" Radiofocus Terumo Angled soft guidewire (TERUMO)

    6. Cannulation of RIIA
    - 5F Tempo Aqua Hydrophilic coating catheter (CORDIS)
    - 0.035" Radiofocus Terumo Angled soft guidewire (TERUMO)

    7. Distal sandwich technique: Deployment of stent graft for REIA and RIIA
    - Viabahn stent graft 10/100-150 mm (GORE)

    8. Postdilatation
    View image
  • - , Main Arena

    Case 15 – Left SFA occlusion

    Center:
    Changi General Hospital, Singapore
    Case 15 – CGH 06: male, 75 years (M-L)
    Operators:
    • Sven Bräunlich,
    • Steven Kum,
    • Tan Yih Kai
    CLINICAL DATA
    Left leg claudication PAOD Rutherford 3
    DM hypertension left CFA
    Endarterectomy right SFA stent
    EF 60%
    CKD Cr 190

    PROCEDURAL STEPS
    1. Contralateral cross-over access via right groin
    - 0.035" Radiofocus angled soft guidewire, 260 cm (TERUMO)
    - 4F Ber II catheter (CORDIS)
    - 0.035" Supra Core guidewire, 300 cm (ABBOTT)
    - 6F 40 cm long Balkin sheath (COOK)
    - CO2 angiography with CO2 Angioset (OPTIMED)

    2. Passage of the lesion with CTO device and predilatation
    - Truepath CTO device (BOSTON SCIENTIFIC)
    - 0.018" Rubicon catheter (BOSTON SCIENTIFIC)
    - 0.018" V-18 control wire, 300 cm (BOSTON SCIENTIFIC)
    - Sterling balloon 4 x 120 (BOSTON SCIENTIFIC)

    3. Treatment with DEB and postdilatation
    - Ranger drug eluting balloon 5/6 x 120 (BOSTON SCIENTIFIC)
    - Mustang balloon 6 x 40 (BOSTON SCIENTIFIC)

    4. Stenting on indication
    - Spot-stenting with Innova stent (BOSTON SCIENTIFIC)
    View image
  • - , Main Arena

    Case 16 – Left SFA in-stent occlusion

    Center:
    Changi General Hospital, Singapore
    Case 16 – CGH 07: male, 55 years (B-P-T)
    Operators:
    • Sven Bräunlich,
    • Tan Yih Kai,
    • Steven Kum,
    • Tjun Tang
    CLINICAL DATA
    Left leg claudication PAOD Rutherford 3
    DM hypertension hyperlipidemia PCI 2011 EF 55% Cr normal
    Left SFA stent in subintimal spot stent Taiwan late 2014

    PROCEDURAL STEPS
    1. Contralateral cross-over access via right groin
    - 0.035" Radiofocus angled soft guidewire, 260 cm (TERUMO)
    - 4F Ber II catheter (CORDIS)
    - 0.035" Supra Core guidewire, 300 cm (ABBOTT)
    - 6/8F 40 cm long Balkin sheath (COOK)

    2. Antegrade passage of the lesion with hydrophilic wire
    - 0.018" V-18 control wire, 300 cm (BOSTON SCIENTIFIC)
    - 0.035" Radiofocus angled soft guidewire, 250 cm (TERUMO)
    - 4F Ber II catheter (CORDIS)

    3. Retrograde puncture of occluded stent in event of antegrade failure
    - 0.035" Radiofocus angled soft guidewire, 250 cm (TERUMO)
    - 4F CXI support catheter, 90 cm

    4. Mechanical thrombectomy and debulking
    - Predilatation with Powercross 3 x 120 balloon (COVIDIEN)
    - 6/8F Rotarex (STRAUB MEDICAL)

    5. Postdebulking IVUS
    - 0.014" Eagle Eye® Platinum IVUS catheter with virtual histology

    6. Treatment with DEB and stenting on indication
    - In.Pact Pacific 5/6 x 120 mm DEB-balloon (MEDTRONIC)
    - SUPERA stent (ABBOTT)
    View image
  • - , Main Arena

    Case 17 – Chronic SFA-occlusion left

    Center:
    University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
    Case 17 – LEI 06: male, 56 years (T-N)
    Operators:
    • Matthias Ulrich,
    • Andrej Schmidt
    CLINICAL DATA
    Severe claudication left calf
    Walking capacity 150 meters
    COPD

    CT
    Long SFA-occlusion left

    ABI
    0.62 left

    PROCEDURAL STEPS
    1. Access right groin and cross-over approach
    - 5F IMA-catheter (CORDIS)
    - 0.035" SupraCore guidewire 200 cm (ABBOTT)
    - 6F-40 cm Balkin Up&Over sheath (COOK)

    2. Passage of the occlusion and PTA
    - 0.035" angled stiff glidewire, 260 cm (TERUMO)
    - 0.035" Seeker support catheter, 135 cm (BARD)
    - 5.0/250 mm Vascutrak balloon (BARD)

    3. PTA with Drug-Coated balloons and stenting on indication
    - 5/150 Lutonix DCB (BARD)
    - LifeStent (BARD)
    View image
  • - , Main Arena

    Case 18 – Right SFA/popliteal occlusion

    Center:
    Changi General Hospital, Singapore
    Case 18 – CGH 08: male, 70 years (A-H-T)
    Operators:
    • Steven Kum,
    • Tan Yih Kai,
    • Sven Bräunlich
    CLINICAL DATA
    Right leg claudication PAOD Rutherford 3
    DM hypertension hyperlipidemia EF 69% Cr normal
    Right CFA endarterectomy and patch Oct 2014 failed antegrade attempt

    PROCEDURAL STEPS
    1. Antegrade access via right groin
    - 6F sheath (TERUMO)

    2. Passage of the lesion with hydrophilic wire
    - 0.018" V-18 control wire, 300 cm (BOSTON SCIENTIFIC)
    - 4F Ber II catheter (CORDIS)

    3. Retrograde PT access in event of antegrade failure
    - 4F Micropuncture® pedal access set (COOK)
    - 0.018" V-18 control wire, 300 cm (BOSTON SCIENTIFIC)
    - 2.6F CXI support catheter, 90 cm (COOK)

    4. Predilatation and lesion preparation
    - 5/6 x 120 mm Fox SV (ABBOTT)
    - 5/6 x 40 mm Armada 35 (ABBOTT)

    5. Stent implantation and postdilatation
    - SUPERA 5 mm x 150 stent (ABBOTT)

    6. Consider treatment of runoff
    - 0.014" COMMAND extra support wire, 300 cm (ABBOTT)
    - 2.5 x 15 NC TREK balloon for PT lesion (ABBOTT)

    7. Implantation of bioabsorbable scaffold
    - 2.5 x 28 ABSORB bioabsorbable vascular scaffold/BVS (ABBOTT) for TPT and PT lesion
    View image
  • - , Main Arena

    Case 20B – Multi-level lesion left (EIA, CFA and SFA-stenosis)

    Center:
    University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
    Case 20B – LEI 07B: male, 49 years (S-P)
    Operators:
    • Andrej Schmidt,
    • Sabine Steiner
    CLINICAL DATA
    Severe claudication left, walking capacity 50 meters
    ABI left 0.4
    CAD with PTCA 2014

    RISK FACTORS
    Smoker
    Art. hypertension

    ANGIOGRAPHY
    Small external iliac artey left, high-grade stenosis left CFA, 
SFA diffusely diseased

    PROCEDURAL STEPS
    1. Access right groin and cross-over approach to left
    - 5F IMA diagnistic catheter (CORDIS)
    - 8F 40 cm Balkin Up&Over sheath (COOK)

    2. Directional atherectomy of the CFA left
    - Spider-Filter 6 mm distal SFA (COVIDIEN/MEDTRONIC)
    - TurboHawk LX-C (COVIDIEN/MEDTRONIC)

    3. PTA of the CFA and SFA
    - In.Pact Pacific 6 mm and 5 mm (MEDTRONIC)
    View image

Conference day 3

  • - , Main Arena

    Case 21 – Infra-renal abdominal aortic aneurysm

    Center:
    Beijing Military Hospital 301, Beijing, China
    Case 21 – BMH 02: male, 75 years
    Operators:
    • Wei Guo,
    • Xin Jia
    CLINICAL DATA
    Documented abdominal aortic aneurysm in May 2012
    Coronary artery disease
    Hypertension

    ANGIOGRAPHY
    CT angiography of abdominal aorta shows:
    Maximum aneurysm diameter 60/57 mm, short and angulated neck
    Right iliac: CIA 18 mm, EIA 9 mm
    Left iliac: CIA 14 mm, EIA 11 mm

    PROCEDURAL STEPS
    1. Bilateral percutanous femoral artery access
    - Perclose preloaded (ABBOTT)

    2. Left brachial artery access for provisional chimney stent
    - 6F 90 cm Flexor long sheath (COOK)
    - Chimney stent in left renal artery: Genesis 6-18 (CORDIS)

    3. Stent graft
    - ENDURANT (MEDTRONIC)
    - Main body from left access: 28-16-170 mm
    - Right leg: 16-20-120 mm
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    Case 22 – Infra renal AAA 6.6 cm with right CIA anuerysm

    Center:
    Singapore General Hospital, Singapore
    Case 22 – SGH 01: male, 80 years (A-A-R)
    Operators:
    • Kiang Hiong Tay,
    • John Wang,
    • Ankur Patel,
    • Jack Ch‘ng
    CLINICAL DATA
    Incidentally detected infra-renal abdominal aortic anuerysm (6.5 x 6.5 cm)
    extending into the right common iliac artery
    Clinical examination: Expansile pulsatile mass in abdomen

    RISK FACTORS
    Hypertension, hyperlipiedemia
    Mild Alzheimer dementia

    CT AORTOGRAM
    6.5 cm infra-renal AAA with anyersmal right CIA (2.7 cm)

    PLAN
    pEVAR with right iliac branch device

    PROCEDURAL STEPS
    1. US guided percutaneous access of both CFAs followed by preclosing with 2 Proglide closure devices.

    2. Aortogram and placement of Lunderquist wire from right side.

    3. Insertion of Zenith iliac branch device (COOK MEDICAL) from right side.
    Snaring of the through and through wire using Indi snare (COOK MEDICAL) from the left side. Insertion of 7F long sheath into the branch from left side. Selective cannulation of the right internal iliac artery and placement of stiff wire (ROSEN).
    Insertion of Atrium covered stent into the right IIA.

    4. Placement of stiff wire (Lunderquist) from left side.
    Insertion of the COOK Zenith stent graft main body from the left side.

    5. Cannulation of the contra-lateral limb from the right side and placement of bridging piece.

    6. Completion of deployment of main body and extension of left ipsilateral limb.

    7. Closure with preclose Proglide.
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    Case 23 – Occlusion of left superficial femoral artery

    Center:
    Beijing Military Hospital 301, Beijing, China
    Case 23 – BMH 03: male, 65 years
    Operators:
    • Wei Guo,
    • Xin Jia
    CLINICAL DATA
    PAOD Rutherford 3
    Intermittent claudication of left leg
    Diabetes mellitus for 20 years
    ABI left 0.45, right 0.72

    PROCEDURAL STEPS
    1. Retrograde access of right groin
    - 0.035" Radiofocus Terumo angled soft guidewire, 180 cm (TERUMO)
    - 6F Flexor straight sheath, 50 cm (COOK)

    2. Passage of the lesion
    - 0.018" V-18 control wire, 300 cm (BOSTON SCIENTIFIC)
    - 4/120 mm Pacific dilatation catheter, 120 cm (MEDTRONIC)

    3. Dilatation and provisional stent
    - 4/120 mm Pacific dilatation catheter,120 cm (MEDTRONIC)
    - 6/150 mm Complete SE Nitinol vascular stent, 120 cm (MEDTRONIC)

    4. Retrograde SFA puncture in case of antegrade failure
    - 0.018" V-18 control wire, 300 cm (BOSTON SCIENTIFIC)
    - 4/120 mm Pacific dilatation catheter, 120 cm (MEDTRONIC)
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    Case 24 – Right SFA chronic total occlusion

    Center:
    Singapore General Hospital, Singapore
    Case 24 – SGH 02: male, 70 years (T-C-H)
    Operators:
    • Farah Gillan Irani,
    • John Wang,
    • Ankur Patel
    CLINICAL DATA
    Right lateral foot wound, started as an abrasion and gotten progressively worse
    Left BKA

    RISK FACTORS
    Poorly controlled diabetes mellitus
    Chronic hyponatreamia

    DOPPLER STUDY
    Long segment SFA occlusion with stenosis in the popliteal artery and ATA occlusion

    ANGIOGRAM
    Long segment calcified SFA occlusion

    PROCEDURAL STEPS
    1. Antegrade right CFA access with US guidance and insertion of 6F Brite tip sheath (CORDIS)

    2. Antegrade recannalisation of SFA
    - 4F Bernstein and 0.035" stiff terumo/ 0.018" V18
    - 2.7F COOK CXI with 0.014" Winn 200T wire (ABBOTT)

    3. If antegrade approach fails for retrograde access via popliteal artery and SAFARI
    - 0.018" V18 and 2.7F Cook CXI catheter

    4. Following crossing angioplasty with DEB +/- stent

    5. Internal balloon tamponade of popliteal access site

    6. Attempts at recannalisation of the ATA

    7. Closure
    - 6F StarClose closure device (ABBOTT)
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    Case 27 – CLI right with occlusion of the TPT and ATA

    Center:
    University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
    Case 27 – LEI 09: male, 73 years (H-G-T)
    Operators:
    • Matthias Ulrich,
    • Andrej Schmidt
    CLINICAL DATA
    CLI with minor gangrene Dig 2 and rest-pain
    Failed antegrade recanalization attempt right Feb 2015
    CAD with PTC 2007
    Atrial fibrillation

    ANGIOGRAPHY
    Occlusion right TPT and ATA

    ABI
    Right 0.32

    PROCEDURAL STEPS
    1. Right antegrade access
    - 6F 55 cm Ansel-sheath (COOK)

    2. Retrograde passage of the ATA
    ADp-puncture with:
    - 3F micropuncture set (COOK)
    - 4 cm 21 Gauge needle (COOK)
    - 3F sheath (COOK)
    - 0.018" Connect 300 cm guidewire (ABBOTT)

    3. Passage of the lesion
    - 0.014" Hydro-ST Guidewire 300 cm (COOK)
    - Advance Micro balloon 2.5/120 mm from retrograde (COOK)
    - Potentially PTA of the TPT and ATA bifurcation in kissing-technique from above and below
    - Xience Prime Everolimus-eluting stent (ABBOTT)
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