Guide to Live Case Transmissions LINC ASIA PACIFIC HONG KONG 2016

Transcription

1 LINC ASIA PACIFIC HONG KONG 2016 AsiaWorld-Expo Hong Kong International Airport Lantau Island, Hong Kong March 8 10, 2016 Guide to Live Case Transmissions

2

3 Guide to Live Case Transmissions During LINC Asia-Pacific interventional and surgical live cases are scheduled to be performed and transmitted to the auditorium. The aim of this booklet is to give you an overview about the live case schedule and to provide a practical guide through the procedures. We hope for your under standing that with respect to the clinical needs of the patients changes of the schedule may occur. Furthermore, the anticipated procedural are just an outline of the procedure. Depending on the discretion of the operator the procedural strategy or the choice of material may vary. 1

4 2

5 LINC ASIA PACIFIC HONG KONG 2016 Tuesday Tuesday, March 8,

6 Tuesday, 08:05 08:30 Live from Mount Sinai Hospital, New York, USA Main Arena Room 1 Case 01 NY 01: male, 71 years, (C-T) Chronic total occlusion RSFA (TASC D) Risk factors: P. Krishnan, K. Gujja, V. Kapur R leg claudication, Rutherford class II, category III, Fontaine IIB US duplex showed occlusion of RSFA Hypertension, diabetes mellitus II, dyslipidemia, ex smoker, PAD 1. Left common femoral access and up and over 7F Pinnacle destination sheath 45 cm, up and over (TERUMO) If necessary, R pedal posterior tibial retrograde access (4F COOK sheath) 2. Intra-luminal approach 0.014" 4F Viance catheter, 150 cm (MEDTRONIC) 0.038" Vertip catheter, 125 cm (CARDINAL HEALTH) 0.014" Confianza wire, 300 cm (ABBOTT VASCULAR) 0.035" Glide wire, 300 cm (TERUMO) 3. Filter placement exchanged with 0.014" Bare wire, 315 cm (ABBOTT VASCULAR) Emboshield filter 4/7 mm embolic protection system (ABBOTT VASCULAR) 4. PTA and stenting as indicated Lutonix drug coated balloons 6.0/150 mm (BARD) Supera stenting 5.5/100 mm (ABBOTT VASCULAR) 4

7 Tuesday, 09:12 09:37 Live from Changi General Hospital, Singapore Main Arena Room 1 Case 02 CGH 01: male, 56 years (E-F) Right SFA occlusion, popliteal stenosis S. Kum, T. Y. Kai, S. Bräunlich PAOD Rutherford 3 Dm hypertension, hyperlipidemia, ex smoker EF 60% Cr 120 Tuesday 1. Cross-over access via right groin 6F Balkin sheath (COOK) 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 PTA 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 vessel preparation 5.0/100 mm Vascutrak scoring PTA catheter (C.R.BARD) 5. PTA with DEB 5/6mm Lutonix drug-coated balloon (C.R.BARD) 6. Spot stent on indication and postdilatation 5/80 mm SUPERA stent (ABBOTT) 5

8 Tuesday, 10:08 10:31 Live from Mount Sinai Hospital, New York, USA Main Arena Room 1 Case 03 NY 02: male, 70 years (A-K) Severely calcified chronic total occlusion of LSFA Risk factors: P. Krishnan, K. Gujja, V. Kapur Left leg pain, Rutherford class II, category III, Fontaine IIB ABI R LE and L LE US duplex showed occlusion of calcified LSFA Hypertension, diabetes mellitus type II, dyslipidemia, ex-smoker, CAD s/p multiple PCI's, PAD 1. Right common femoral access and cross-over approach 7F Pinnacle destination sheath 45 cm up and over sheath (TERUMO) 2. Guide wire passage 0.014" Spartacore wire, 300 cm (ABBOTT VASCULAR) 0.038" Vertebral 135" Tempa Aqua catheter, 125 cm (CARDINAL HEALTH) 0.014" Confianza wire, 300 cm (ABBOTT VASCULAR) 0.035" Glide wire, 300 cm (TERUMO) 3. Filter placement exchanged with 0.014/Bare wire, 315 cm (ABBOTT VASCULAR) Emboshield filter 4/7 mm embolic protection system (ABBOTT VASCULAR) 4. Athrectomy and thrombectomy, if embolization occurs Jet stream Pathway rotational athrectomy 2.4/3.4 (BOSTON SCIENTIFIC) Penumbra aspiration thrombectomy (PENUMBRA) 5. PTA and stenting as indicated Lutonix drug coated balloons 6.0/150 mm (BARD) Supera stenting 5.5/100 mm (ABBOTT VASCULAR) 6

9 Tuesday, 11:16 11:41 Live from Mount Sinai Hospital, New York, USA Main Arena Room 1 Case 04 NY 03: male, 76 years (J-S) Chronic total occlusion with in-stent occlusion in mid segment RSFA P. Krishnan, K. Gujja, V. Kapur Risk factors: R leg claudication, Rutherford class II, category III, Fontaine IIB US duplex showed occlusion of RSFA with instent occlusion in mid RSFA Hypertension, diabetes mellitus II, dyslipidemia, ex smoker, PAD Tuesday 1. Left common femoral access and up and over 7 Fr Pinnacle destination sheath 45 cm, up and over (TERUMO) If necessary, R pedal posterior tibial retrograde access (4F COOK sheath) and direct stent access 2. Intra-luminal approach 0.014" 4F Viance catheter, 150 cm (MEDTRONIC) 0.038" Vertip catheter, 125 cm (CARDINAL HEALTH) 0.014" Confianza wire, 300 cm (ABBOTT VASCULAR) 0.035" Glide wire, 300 cm (TERUMO) 3. Thrombectomy Angiojet Rheolytic aspiration thrombectomy (BOSTON SCIENTIFIC) or Penumbra aspiration thrombectomy (PENUMBRA) 4. Filter placement Spider filter 7 mm (MEDTRONIC) 5. Athrectomy and thrombectomy, if embolization occurs Silver Hawk Directional athrectomy LSM (MEDTRONIC) Penumbra aspiration thrombectomy (PENUMBRA) 6. PTA and stenting as indicated INPACT drug coated balloons 6.0/120 mm (MEDTRONIC) Supera stenting 5.5/100 mm (ABBOTT VASCULAR) 7

10 Tuesday, 11:41 12:06 Live from Changi General Hospital, Singapore Main Arena Room 1 Case 05 CGH 02: male, 58 years (O-E) Right SFA occlusion, iliac stenosis S. Kum, T. Y. Kai, S. Bräunlich PAOD Rutherford 5 right ankle wound, Left fem-pop bypass, left CIA BMS 2 weeks ago ESRF DM EF 60% 1. Brachial access via left brachial artery 6F x 90 cm Shuttle sheath (COOK) 2. Stenting of right iliac lesion 8/9 mm Assurant Cobalt balloon mounted stent for CIA (MEDTRONIC) 8mm Complete SE self expanding stent for EIA (MEDTRONIC) Post dilatation 7/8 mm REEF HP balloon (MEDTRONIC) 3. Passage of lesion with GW Standard J-Tip guidewire, 150 cm (CARDINAL HEALTH) 4. Retrograde SFA access in event of antegrade failure, rendezvous and predil via brachial Pacific 4 x 120 balloon x 180 shaft length (MEDTRONIC) 5. Antegrade right CFA access and treatment of right SFA In.Pact Pacific 5/6 x 120 mm DEB-balloon (MEDTRONIC) Spot-stenting with a COMPLETE SE or Everflex stent (MEDTRONIC) 6. Consider DEB of PFA 8

11 Tuesday, 13:15-14:15 Live from University Hospital Leipzig, Germany Main Arena Room 1 Case 06 LEI 01: male, 69 years (K-O) Restenosis after CEA right ICA 2005 A. Schmidt, M. Ulrich Progressive, asymptomatic restenosis right internal carotid artery after CEA 2005 CEA left ICA 2007 CAD, MI and PTCA 2012 art. hypertension Tuesday Duplex: Progression to 3.5 m/sec. right ICA 1. Access right groin 9F 20 cm sheath (TERUMO) 2. Cannulation of the right external carotid artery Judkins Right 5F diagnostic catheter (CARDINAL HEALTH) 0.035" soft angled glidewire, 180 cm (TERUMO) 0.035" SupraCore 300 cm stiff guidewire (ABBOTT) 3. Cerebral protection MOMA endovascular clamping device 9F (MEDTRONIC) 4. Cannulation, predilatation, stenting and postdilatation of the right ICA 0.014" Galleo Pro 175 cm guidewire (BIOTRONIK) MiniTreck RX-balloon 3.5/20 mm (ABBOTT) CGuard carotid embolic protection system (Inspire MD/PENUMBRA) 5.0/20 mm RX-balloon (BOSTON SCIENTIFIC) 9

12 Tuesday, 14:30 14:53 Live from University Hospital Leipzig, Germany Main Arena Room 1 Case 07 LEI 02: female, 62 years (M-Z) Reocclusion right SFA Risk factors: A. Schmidt, M. Ulrich Reocclusion right SFA Claudication right calf, walking capacity 150 meters, ABI right 0.67 PTA right SFA 2012 with plane balloon angioplasty elsewhere PTA left SFA/stenting 2013 Re-PTA left SFA 12/ cm long reocclusion right mid SFA art. hypertension, former smoker, diabetes mellitus type 2 1. Access left groin and cross-over approach 5F diagnostic IMA-catheter (CARDINAl HEALTH) 0.035" soft angled glidewire 180 cm (TERUMO) 0.035" stiff SupraCore guidewire 190 cm (ABBOTT) 2. Passage of the right SFA-CTO 0.018" Cruiser S 300 cm guidewire (BIOTRONIK) Passeo 4/120 mm balloon (BIOTRONIK) 3. PTA with drug-coated balloons and stenting on indication Passeo LUX DCB 5.0/120 mm (BIOTRONIK) Pulsar 18 stent (BIOTRONIK) 10

13 Tuesday, 15:03 15:25 Live from Changi General Hospital, Singapore Main Arena Room 1 Case 08 CGH 03: female, 63 years (K-C-E) Left SFA occlusion S. Bräunlich, S. Kum, T. Y. Kai PAOD Rutherford 3 COPD hypertension hyperlipidemia IHD EF 55% Cr normal Tuesday 1. Antegrade access via left groin 6F sheath 2. Passage of the lesion 0.018" V-18 hydrophilic control wire, 300 cm (BOSTON SCIENTIFIC) 4F Ber II catheter (CARDINAL HEALTH) 3. Predilatation and lesion preparation 4. PTA with DEB Lux 5/6 x 120 mm DEB-balloon (BIOTRONIK) 5. Postdilatation and stent Conquest 5/6 x 40 balloon (BARD) 4F Pulsar 18 stent (BIOTRONIK) 11

14 Tuesday, 16:01 16:20 Live from University Hospital Leipzig, Germany Main Arena Room 1 Case 09 LEI 03: male, 76 years (H-M) Occlusion left SFA Risk factors: A. Schmidt, M. Ulrich Severe claudication left calf, walking capacity 150 meters, ABI left 0.65 Abdominal aortic aneurysm 3.2 cm Chronic renal insufficiency, GFR 35 ml/min COPD CO2-angiography: long SFA-occlusion left art. hypertension, former nicotin-abuse 1. Access right groin and cross-over approach 5F diagnostic IMA-catheter (CARDINAL HEALTH) 0.035" soft angled glidewire 180 cm (TERUMO) 0.035" stiff SupraCore guidewire 190 cm (ABBOTT) 2. Passage of the left SFA-CTO 0.035" stiff angled glidewire, 260 cm (TERUMO) CXC 0.035" 135 cm support catheter (COOK) 3. PTA and stenting Advance 35 balloon (COOK) Zilver-PTX drug-coated stent (COOK) 12

15 Tuesday, 16:36 17:10 Live from University Hospital Leipzig, Germany Main Arena Room 1 Case 10 LEI 04: male, 77 years (M-P) Popliteal occlusion right, CLI A. Schmidt, M. Ulrich Restpain right foot, ABI right 0.44 Failed recanalization attempt 12/2015 and 1/2016 elsewhere CAD, PTCA 2013 and 2014 Minor stroke 2012 Tuesday Risk factors: Angiography during previous recanalization-attempt: Popliteal occlusion right, failure to pass into the posterior tibial artery art. hypertension, former nicotin-abuse, diabetes mellitus type 2 1. Access right groin anetgrade 6F 55 cm sheath (COOK) 2. Retrograde access via posterior tibial artery Transpedal access kit (COOK) (21 Gauge 4 cm needle, 2.9F sheath) 3. Retrograde CTO-passage and PTA 0.014" CTO-Approach guidewire 18 gramm, 300 cm (COOK) CXI 0.018" angled support-catheter, 90 cm (COOK) Advance Micro Balloon 3.0/80 mm, 90 cm (COOK) 4. PTA and stenting from antegrade Advance mm balloon (COOK) Zilver-PTX stent for the proximal popliteal artery (COOK) Failed antegrade PTA 13

16 Tuesday, 17:30 18:00 Live from Changi General Hospital, Singapore Main Arena Room 1 Case 11 CGH 04: male, 58 years (P-C-M) May Thurner syndrome and GSV reflux S. Kum, T. Y. Kai, S. Bräunlich Left leg swelling. Venous claudication and swelling x 100 metres Hypt, hyperlipidemia, AF on Dabigatran (Pradaxa), previous DVT years ago. CT venogram done. Duplex shows left SFJ/GSV reflux 1. Left mid GSV access under ultrasound 5F Terumo sheath 12F Peel-away safe-sheath (ANGIODYNAMICS) 2. Passage of the lesion with hydrophilic wire and stiff wire 0.035" Radiofocus Terumo angled soft guidewire, 260 cm (TERUMO) 4F Ber II catheter (CORDIS) 0.035" Supra Core guidewire, 300 cm (ABBOTT) 3. Venogram and IVUS 8.5F Visions PV.035 (VOLCANO) 4. Predilatation 16/18 x 40 Atlas balloon (BARD) 5. Iliac vein stenting Wallstent 18 x 90 (BOSTON SCIENTIFIC) 6. Postdilatation and IVUS control 16/18 x 40 Atlas balloon (BARD) 7. RFA of GSV Venefit with ClosureFast catheter to GSV 14

17 Tuesday, 13:05 14:15 Live from Changi General Hospital, Singapore Technical Forum Room 2 Case 12 CGH 05: male, 66 years (T-C-B) Right CLI and ATA occlusion S. Kum, T. Y. Kai, S. Bräunlich CLI right 2nd toe gangrene PAOD Rutherford 5 DM hypertension hyperlipidemia IHD EF 45% Cr 102. Recent cross-over POBA for SFA CTO, pop and peroneal stenosis Tuesday 1. Antegrade access via right groin 5F Terumo sheath 2. Antegrade passage of the lesion with hydrophilic wire 0.014" COMMAND extra support wire 300 cm (ABBOTT) 2 x 40 Advance 14LP balloon (COOK) 3. Retrograde passage of lesion via ultrasound guided DP puncture 4F Micropuncture Transpedal Set (COOK) EDGE ultrasound high frequency probe (SONOSITE) COMMAND extra support wire 300 cm (ABBOTT) 2 x 40 Advance Micro 14 via retrograde 4. PTA of ATA 3.0 x 120 mm Jade high pressure balloon (ORBUS NEICH) 5. Consider DEB/stent if any SFA/pop restenosis seen 15

18 16

19 LINC ASIA PACIFIC HONG KONG 2016 Wednesday, March 9, 2016 Wednesday 17

20 Wednesday, 08:00 08:30 Live from Taipei Tzu Chi General Hospital, Taipei City, Taiwan Main Arena Room 1 Case 13 TTC 01: male, 83 years (C-C) Restenosis and reocclusion of left TP trunk to posterior tibial artery Hsin-Hua Chou, Hsuan-Li Huang Bilateral feet resting pain (left > right) with ulceration at left great toe for 1 month PTA for left TP trunk and post. tibial A 02/2013 PTA and stenting for right SFA 01/2016, PTA for right peroneal artery 01/2016 ESRD under regular H/D, 3-V CAD s/p PCI, Type 2 DM, HTN ABI: right:0.73; left:0.58 Angiography: Stenosis at left popliteal artery, restenosis at left TP trunk to single remaining post. tibial A, reocclusion at left distal post. tibial A 1. Left CFA antegrade access 6F 10 cm sheath (TERUMO) 6F 55 cm Multipurpose guiding catheter (BOSTON SCIENTIFIC) 2. Passage of the lesion(s) 0.014" PT2 guidewire, 300 cm (BOSTON SCIENTIFIC) 0.018" CXI support-catheter, 150 cm (COOK) In case of failure, exchange to V-18 control guidewire, 300 cm (BOSTON SCIENTIFIC) 3. Lesion preparation Amphirion Deep, /210 mm (MEDTRONIC) 4. Drug-coated balloon angioplasty Lutonix 014 Drug-coated balloon, 2.5/120 mm for distal post. tibial A (COOK) Lutonix 014 Drug-coated balloon, 3.0/120 mm for proximal post. tibial artery (COOK) 5. Stenting for TP trunk on indication Bioabsorbable vascular scaffold 3.5/28 mm (ABBOTT) With/without OCT study (ST. JUDE MEDICAL) 6. Drug-coated balloon angioplasty In.PACT Admiral drug-coated balloon 4.0/80 mm for pop. A (MEDTRONIC) 18

21 Wednesday, 09:09 09:40 Live from Changi General Hospital, Singapore Main Arena Room 1 Case 14 CGH 06: female, 91 years (P-M) Left SFA and ATA occlusion, TPT stenosis S. Kum, T. Y. Kai, S. Bräunlich Left leg shallow wounds and rest pain PAOD Rutherford 5 DM hypertension right SFA in-stent occlusion Rotarex and DEB Left 4th /5th toe dermal gangrenet, EF 60%, Cr normal Wednesday 1. Contralateral cross-over access via right groin 6F 40 cm long Balkin sheath (COOK) 2. Passage of the lesion 0.018" V-18 control wire, 300 cm (BOSTON SCIENTIFIC) 0.035" Terumo angled Soft/Stiff guide-wire, 260 cm (TERUMO) 4F Ber II catheter (CORDIS) 3. Treatment with stent /DEB SUPERA 5 X 150 (ABBOTT) after predil with DORADO 6 x 40 (BARD) 4. ATA recanalization via antegrade (retrograde DP access in event of failure) 0.014" Command ES Wire (ABBOTT) Armada /3 x 120 (ABBOTT) 5. Treatment of TPT 3.5 x 15 NC TREK balloon for TPT lesion (ABBOTT) 3.5 x 28 ABSORB Bioabsorbable Vascular Scaffold/BVS (ABBOTT) for TPT lesion Post Dil 3.5 x 15 NC TREK balloon (ABBOTT) 19

22 Wednesday, 11:03 11:35 Live from Beijing PLA Hospital, Beijing, China Main Arena Room 1 Case 15 BPH 01: female, 65 years Left SFA long occlusion Wei Guo, Xin Jia Claudication of left leg for 6 months; Rutherford 3 Risk factors: Diabetes, hypertension 1. Right femoral retrograde access and cross-over 6F 40 cm long sheath (COOK) 2. Crossing the occlusion 0.018" V-18 Control guidewire, 300 cm (BOSTON SCIENTIFIC) 3. Retrograde distal SFA bailout access for unsuccessful passage 4. Predilatation 4/220 mm SAVVY Long OTW balloon, 130 cm (CORDIS) 5. DCB and proventional stent 5/200 mm Orchid DCB Balloon, 130 cm (ACOTEC) 6.0/200 mm, EVERFLEX, Nitinol stent system 120 cm (EV3) 20

23 Wednesday, 11:45 12:30 Live from Changi General Hospital, Singapore Main Arena Room 1 Case 16 CGH 07: female, 88 years (S-A-L) Left SFA in-stent occlusion S. Kum, T. Y. Kai, S. Bräunlich Left leg claudication PAOD Rutherford 4 DM hypertension hyperlipidemia PPM previous left SFA stenting 1. Contralateral cross-over access via Right groin 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 Terumo angled soft guidewire, 250 cm (TERUMO) 3. Retrograde puncture of occluded stent in event of antegrade failure 0.035" Radiofocus Terumo angled soft guidewire, 250 cm (TERUMO) 4F CXI support catheter 4. Mechanical thrombectomy and debulking Predilatation with Powercross 2/3 x 120 balloon (MEDTRONIC) 8F Rotarex (STRAUB MEDICAL) Wednesday 5. Post debulking IVUS o.014" Eagle Eye Platinum IVUS catheter with virtual histology 6. Treatment with DEB and stent on indication 21

24 Wednesday, 13:46 14:16 Live from University Hospital Leipzig, Germany Main Arena Room 1 Case 17 LEI 05: male, 61 years (K-M) SFA occlusion left M. Ulrich, A. Schmidt Severe claudication left calf, walking capacity 200 meters, ABI left 0.67 CAD, PTCA 2013 Duplex: Risk factors: Long SFA-occlusion left Art. hypertension, nicotin abuse 1. Access right groin and cross-over approach 5F diagnostic IMA-catheter (CARDINAl HEALTH) 0.035" soft angled glidewire 180 cm (TERUMO) 0.035" stiff SupraCore guidewire 190 cm (ABBOTT) 2. Guidewire passage Mustang balloon 5.0/120 mm (BOSTON SCIENTIFIC) 0.035" stiff angled glidewire, 260 cm (TERUMO) in case of failure to reenter distal: attempt with Victory gramm 300 cm (BOSTON SCIENTIFIC) 3. PTA with drug-coated balloons and stenting on indication Ranger DCB (BOSTON SCIENTIFIC) EPIC selfexpanding nitinol-stent (BOSTON SCIENTIFIC) 22

25 Wednesday, 14:32 15:00 Live from Changi General Hospital, Singapore Main Arena Room 1 Case 18 CGH 08: female (J-L) May Thurner syndrome T. Y. Kai, S. Kum, S. Bräunlich Left leg swelling. Recent cellulitis Hypothyroidism, recent left calf DVT on Warfarin. CT venogram done. 1. Left mid SFV access under ultrasound 5F Terumo sheath 12F Peel-away Safe-sheath (ANGIODYNAMICS) 2. Passage of the lesion with hydrophilic wire and stiff wire 0.035" Radiofocus Terumo angled soft guidewire, 260 cm (TERUMO) 4F Ber II catheter (CORDIS) 0.035" Supra Core guidewire, 300 cm (ABBOTT) 3. Venogram and IVUS 8.5F Visions PV.035 (VOLCANO) 4. Predilatation 16/18 x 40 Atlas balloon (BARD) Wednesday 5. Iliac Vein Stenting Wallstent 18 x 90 (BOSTON SCIENTIFIC) 6. Postdilatation and IVUS control 16/18 x 40 Atlas balloon (BARD) 23

26 Wednesday, 15:24 16:02 Live from University Hospital Leipzig, Germany Main Arena Room 1 Case 19A LEI 06A: male, 61 years (F-H) Flush occlusion right SFA A. Schmidt, M. Ulrich Severe claudication right calf, walking capacity 100 meters, ABI right 0.54 CAD, MI and PTCA 2012 Renal artery stenosis PTA 2013 COPD failed antegrade recanalization attempt right SFA 2/ Access left groin and cross-over approach 5F diagnostic IMA-catheter (CARDINAl HEALTH) 0.035" soft angled glidewire 180 cm (TERUMO) 0.035" stiff SupraCore guidewire 190 cm (ABBOTT) 2. Guidewire passage of the right SFA-flush-occlusion 0.035" stiff angled glidewire, 260 cm (TERUMO) 5F diagnostic IMA-catheter (CARDINAl HEALTH) In case of failure to enter the CTO retrograde approach via distal SFA: 9 cm 21 Gauge needle (COOK) 0.018" V-18 Control guidewire 300 cm (BOSTON SCIENTIFIC) 0.018" Seeker support catheter 90 cm (BARD) 3. PTA and stenting on indication VascuTrak scoring balloon 5.0/300 mm (BARD) Lutonix 5.0 or mm DCB (BARD) Lifestent (BARD) 24

27 Wednesday, 15:24 16:02 Live from University Hospital Leipzig, Germany Main Arena Room 1 Case 19B LEI 06B: male, 81 years (F-F) 3-vessel occlusion right BTK, CLI A. Schmidt, Y. Bausback PAOD Rutherford 5, forefoot right SFA-Angioplasty right 02/2016 CAD, PTCA 8/2013 Diabetes mellitus type 2 former smoker Angiography: Occlusion of all 3 BTK vessels, collateral filling of the distal peroneal artery and dorsalis pedis artery 1. Antegrade access right groin 5F 55 cm Flexor Check-Flo introducer (COOK) 2. Antegrade passage and PTA Command ES guidewire 300 cm (ABBOTT) Ultraverse 0.014" balloon 2.0/120 mm (BARD) VascuTrak 2.5/250 mm Balloon (BARD) Wednesday 3. In case of antegrade failure: retrograde puncture of the dorsalis pedis / peroneal artery 21 Gauge / 7 cm needle (COOK) Connect 300 cm guidewire (ABBOTT) Seeker support catheter 0.018" 90 cm (BARD) 4. PTA with DCBs Lutonix 2.5/150 mm DCB (BARD) 25

28 Wednesday, 16:30 18:00 Live from Beijing PLA Hospital, Beijing, China Main Arena Room 1 Case 20 BPH 02: male, 73 years Left iliac occlusion Wei Guo, Xin Jia Claudication of left leg for 8 months; Rutherford 3 Risk factors: Smoking; hypertension; CAD 1. Right brachial access 6F 90 cm long sheath (COOK) 2. Crossing the occlusion 0.018" V-18 Control guidewire, 300 cm (BOSTON SCIENTIFIC) 3. Left femoral retrograde bailout access 4. PTA and proventional stent 6/80 mm ADMIRAL OTW balloon, 130 cm (MEDTRONIC) 8/120 mm, COMPLETE SE,nitinol stent system 120 cm (MEDTRONIC) 26

29 Wednesday, 16:30 18:00 Live from University Hospital Leipzig, Germany Main Arena Room 1 Case 21 LEI 07: male, 57 years (D-R) Popliteal occlusion right, CLI A. Schmidt, M. Ulrich PAOD Rutherford 4, restpain right, severe claudication, walking capacity 100 meters ABI right 0.44 Aortic valve replacement 2009 Diabetes mellitus type 2 former smoker PTA of a proximal SFA-stenosis right 1/2016, failed antegrade passage of the popliteal occlusion right Wednesday 1. Antegrade access right groin 7F 55 cm Flexor Check-Flo Introducer (COOK) 2. Retrograde passage via the anterior tibial artery 7 cm 21 gauge needle (COOK) 0.018" QuickCross support catheter 90 cm (SPECTRANETICS) 0.018" Connect guidewire 300 cm (ABBOTT) Snaring of the retrograde guidewire from retrograde 3. Atherectomy 4 mm Spider filter (MEDTRONIC) HawkOne 6 cm tip (MEDTRONIC) 4. PTA with DCBs In.Pact Pacific DCB (MEDTRONIC) 27

30 Wednesday, 16:30 18:00 Live from University Hospital Leipzig, Germany Main Arena Room 1 Case 22 LEI 08: female, 79 years (I-S) Forefoot ulcerations right, Bullfrog-PTA A. Schmidt, Y. Bausback PAOD Rutherford 5, forefoot-ulcerartion right, restpain toes ABI right 0.22 PTA of a popliteal stenosis right, failure to recanalize a posterior tibial occlusion from antegrade CAD, PTCA 2004 Diabetes mellitus type 2 with diabetic nephropathy, GFR 53 ml/min paroxysmal atrial fibrillation BTK: patent peroneal artery, flush-occlusion of the posterior tibial artery 1. Antegrade access right groin 6F 55 cm Flexor Check-Flo introducer (COOK) 2. Retrograde passage via the posterior tibial artery transpedal puncture-kit (COOK) (4 cm 21 gauge needle, 2.9F sheath) CXI 0.018" 90 cm support catheter (COOK) CTO-Approach 0.014" guidewire, 18 gramm, 300 cm (COOK) Advance Micro-balloon 2.5/120 mm (COOK) 3. PTA and arterial wall-injection of dexamethason BullFrog Micro-Infusion-Device (MERCATOR MEDSYSTEMS) 28

31 Wednesday, 12:30 14:15 Live from Taipei Tzu Chi General Hospital, Taipei City, Taiwan Technical Forum Room 2 Case 23 TTC 02: male, 60 years, (Chen) Calcified stenosis of left common femoral artery Hsuan-Li Huang, Hsin-Hou Chou Intermittent claudication of left leg for months Diabetes mellitus, arterial hypertension, hyperlipidemia Duplex US showed the dampened waveform distal to CFA The ABI levels: left 0.77, right 0.89 CTA: heavily calcified stenosis involving Lt CFA, mild stenosis at left middle SFA 1. Right femoral cross-over access 8F Balkin 40 cm cross-over sheath (COOK) 2. Guidewire passage and distal protection 0.014" PT2 guidewire 300 cm (BOSTON SCIENTIFIC) Spider FX embolic protection device (MEDTRONIC-COVIDIEN) 3. IVUS assessment Visions PV catheter (VOLCANO) 4. Directional atherectomy Turbohawk LS-C or LX-C (MEDTRONIC-COVIDIEN) Wednesday 5. Drug coated balloon angioplasty In.PACT Admiral 0.035" 7.0/60 mm (MEDTRONIC) 29

32 30

33 LINC ASIA PACIFIC HONG KONG 2016 Thursday, March 10, 2016 Thursday 31

34 Thursday, 08:00 08:25 Live from Taipei Veterans General Hospital, Taipei City, Taiwan Main Arena Room 1 Case 24 TAI 01: male, 71 years (HSU,T-S) Right common iliac artery aneurysm Shih Chun-Che, Chen Po-Lin, Chen I-Ming Right common iliac artery aneurysm 4 cm Hypertension, hyperlipidemia 1. Main body of AAA stent graft (ENDURANT II, MEDTRONIC) mm from left 2. Home-made fenestration graft for RIIA mm iliac limb (MEDTRONIC) 3. RIIA covered stent 7F 90 cm Flexor Check-Flo Performer from left brachial artery (COOK) mm Advanta V12 covered stent (ATRIUM) 4. Left iliac limb mm (MEDTRONIC) 5. Right iliac bridging limb mm (MEDTRONIC) 6. Postdilatation Reliant balloon (MEDTRONIC) 32

35 Thursday, 09:13 09:38 Live from Singapore General Hospital, Singapore Main Arena Room 1 Case 25 SGH 01: male, 65 years (CKM) Chimney EVAS Tze Tec Chong, Tay Kiang Hiong Asymptomatic 6.9cm AAA Ex-smoker, hypertensive, hyperlipidaemia, chronic obstructive airway disease, ischemic heart disease, mulitnodular goitre, chronic kidney disease (baseline scr 300+), anaemia of chronic illness (Hb 7 to 8 g/dl), Ca prostate (conservative treatment) Ischemic bowel s/p subtotal colectomy and ileostomy in Bilateral femoral arterial punctures, US guided, pre close with Proglide x 2 each side. Bilateral brachial arterial punctures, US guided, 6F sheaths 2. Both renal arteries cannulated from brachial approach with Terumo glidewire and MPA catheter. Exchanged for Rosen wire and 7F x 90cm Destination sheaths (TERUMO) to introduce 5x38 mm BeGraft (INNOMED) for renal chimneys 3. Nellix device introduced from below over Lunderquist wires. Test fill endobags with saline followed by angio run to confirm good aneurysm seal/exclusion. 4. Fill endobags with polymer and allow to cure. Check for endoleaks. Secondary fill if needed. Thursday 33

36 Thursday, 10:34 10:58 Live from Beijing PLA Hospital, Beijing, China Main Arena Room 1 Case 26 BPH 03: male, 55 years Acute aortic dissection (stanford type B) Risk factors: Wei Guo, Xin Jia Acute back pain 20 days ago Maximal thoracic aortic diameter 5.0 cm Hypertension, smoking 1. Left brachial access for angiogram 2. Right femoral access preclose technique Proglide preloaded (ABBOTT) 3. Stentgraft implantation Castor branched stentgraft (MICORPORT) 34

37 Thursday, 11:00 11:25 Live from Singapore General Hospital, Singapore Main Arena Room 1 Case 27 SGH 02: male, 70 years (DFN) Left brachiocephalic vein occlusion Ankur Patel, Leong Sum Recurrent left arm swelling Diabetic, hypertensive, hyperlipidaemia, ischaemic heart disease. End stage kidney disease on hemodialysis via left arm brachiocephalic AVF x 6 years. Current state: Had left arm swelling 3 months ago due to left brachiocephalic vein occlusion treated successfully with balloon angioplasty. Now symptoms recurred. 1. Antegrade puncture of left BCAVF, 7F sheath 2. Lesion crossing Terumo glidewire and 4F Ber catheter Right femoral approach if lesion crossing failed via arm approach. 3. Angioplasty 14.0/40 mm Conquest balloon (BARD) 4. Stenting if poor result Sinus XL stent (OPTIMED) Pre Post Thursday 35

38 Thursday, 11:49 12:20 Live from Taipei Veterans General Hospital, Taipei City, Taiwan Main Arena Room 1 Case 28 TAI 02: female, 41 years (HSU,T-S) AV graft stenosis Chen Po-Lin, Chen I-Ming ESRD s/p PD for 2 years, shifted to HD since 2013/07 due to peritonitis Right forearm loop AVG was created on 2013/08. High pressure since 2014/12 Type 1 DM, hypertension Left renal cell carcinoma s/p laparoscopic radial nephrectomy in Antegrade puncture of AV graft 7F 5 cm sheath (TERUMO) 2. PTA to venous anastomosis and basilic vein with DEB 6/80 mm Admiral (MEDTRONIC) 7/80 mm InPact Admiral DEB (MEDTRONIC) 36

39 Thursday, 13:15 16:00 Live from Singapore General Hospital, Singapore Main Arena Room 1 Case 29 SGH 03: female, 75 years (CEM) Long segment SFA and ATA CTO Tay Kiang Hiong, Karthikeyan Damodharan Non healing right big toe ulcer x 3 months Diabetic, hypertensive, hyperlipidaemia, ischaemic heart disease with CABG 10 yrs ago (EF 50%), end stage kidney disease on hemodialysis Toe pressures: right 40mmHg, left 129mmHg Duplex scan of right leg showed long segment CTO of upper/mid SFA and anterior tibial 1. Ultrasound guided downhill puncture 6F Britetip sheath 2. Subintimal crossing of SFA CTO Terumo glidewire and 4F Ber catheter Retrograde popliteal access if antegrade crossing failed. Thursday 3. Angioplasty 6.0/200mm Mustang balloon (BOSTON SCIENTIFIC) Ranger drug eluting balloon (BOSTON SCIENTIFIC) 4. Subintimal crossing of ATA/DP CTO V18 Control wire and 4F Ber catheter. Pedal plantar loop technique if antegrade crossing failed. 5. Angioplasty 3.0/150 mm Sterling balloon (BOSTON SCIENTIFIC) Ranger drug eluting balloon (BOSTON SCIENTIFIC) 37

40 Thursday, 13:15 16:00 Live from University Hospital Leipzig, Germany Main Arena Room 1 Case 30 LEI 09: male, 54 years (J-K) Iliac occlusion left with failed recanalization attempt A. Schmidt, M. Ulrich PAOD Rutherford 3, severe claudication left leg ABI left 0.71 Stenting right common iliac artery 2012, Unsuccessful recanalizaiton attempt left CIA 1/2016 elsewhere CAD, PTCA 6/2015 Diabetes mellitus type 2, current smoker Angiography: Common iliac occlusion left, plaque distal abdominal aorta, stent CIA right patent 1. Left brachial access 7F 90 cm Check-Flow-Performer sheath (COOK) Left femoral approach 11F 25 cm Radiofocus II sheath (TERUMO) 2. Guidewire passage of the occlusion left CIA transbrachial: 5F 125 cm Judkins Right Diagnostic catheter (CARDINAL HEALTH) 0.035" stiff angled glidewire, 260 cm (TERUMO) left femoral: 5F 80 cm Multipurpose Diagnostic catheter (CARDINAL HEALTH) 0.035" stiff angled glidewire, 260 cm (TERUMO) potentially double-balloon technique 3. Stenting Sinus aortic stent for the abdominal aorta (OPTIMED) Lifestream 8/57 mm covered stent left CIA (BARD) Lifestream 8/37 mm covered stent right CIA (BARD) 38

41 Thursday, 13:15 16:00 Live from Beijing PLA Hospital, Beijing, China Main Arena Room 1 Case 31 BPH 04: male, 68 years Right SFA long occlusion and BTK lesions Risk factors: Wei Guo, Xin Jia PAOD Rutherford 5, gangrene at 4 and 5 toes Diabetes, smoking 1. Left femoral retrograde access 6F 40 cm cross-over sheath (COOK) 2. Crossing the occlusion 0.018" V-18 Control guidewire, 300 cm (BOSTON SCIENTIFIC) 0.014" PT2 wire (BOSTON SCIENTIFIC) 3. Retrograde peroneal artery puncture (bailout access) Thursday 4. PTA and proventional stent 4/220 mm SAVVY long OTW Balloon, 130 cm (CORDIS) 6.0/200 mm, EVERFLEX, Nitinol Stent System 120 cm (EV3) 39

42 Thursday, 13:15 16:00 Live from University Hospital Leipzig, Germany Main Arena Room 1 Case 32 LEI 10: male, 57 years (P-K) Popliteal occlusion right, CLI Risk factors: A. Schmidt, Y. Bausback PAOD Rutherford 4, Restpein right foot ABI left 0.44 PTA left SFA and popliteal artery 1/2016 CEA right groin 2012 Diabetes mellitus type 2, current smoker Angiography: Occlusion distal SFA / Apop artery right 1. Right groin antegrade access 6F 55 cm Check-Flow-Performer sheath (COOK) 2. Guidewire passage: 0.018" Connect guidewire, 300 cm (ABBOTT) CXC 0,018" 90 cm support catheter (COOK) In case of failure: 0.035" stiff angled glidewire (TERUMO) CXC 0,035" 90 cm support catheter (COOK) If failure: retrograde access via posterior tibial artery 3. PTA and stenting Armada 35 balloon (ABBOTT) Supera Interwoven nitinol stent (ABBOTT) 40

43 Live case transmission performing centres University Hospital Leipzig, Division of Interventional Angiology Leipzig, Germany Andrej Schmidt Matthias Ulrich Yvonne Bausback Beijing PLA Hospital Beijing, China Wei Guo Xin Jia Changi General Hospital Singapore Steven Kum Tan Yih Kai Guest: Sven Bräunlich Taipei Veterans General Hospital Taipei City, Taiwan Shih Chun-Che Chen Po-Lin Chen I-Ming Taipei Tzu Chi General Hospital Taipei City, Taiwan Hsuan-Li Huang Hsin-Hua Chou Hsin-Hou Chou Mount Sinai Hospital New York, USA Prakash Krishnan K. Gujja V. Kapur Singapore General Hospital, Singapore Tay Kiang Hiong Tze Tec Chong Ankur Patel Leong Sum Karthikeyan Damodharan

44 The venue AsiaWorld-Expo Hong Kong International Airport Lantau Island, Hong Kong Congress production Provascular GmbH Sonnenleite Heroldsbach, Germany Congress organisation Congress Organisation and More GmbH Antonie Jäger Ruffinistrasse Munich Germany Phone: Fax: E.mail: info@cong-o.de