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)
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
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)
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
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)
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)
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)
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
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)
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)
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