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