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Experts opinion
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LINC 2020: Prestige Pilot study — IVUS guided atherectomy and DCB therapy Dr Michael Lichtenberg

Dr Michael Lichtenberg (Vascular Centre Clinic Arnsberg, Arnsberg, DE) discusses the latest findings from the Prestige Pilot study. Prestige Pilot investigates if a lesion preparation strategy with Phoenix® atherectomy before DCB (drug coated balloon) usage in patients with PAD (peripheral artery disease) Rutherford Stage 4-5 and mild/moderate/severe calcium can improve outcomes including patency and limb salvage and evaluate safety and performance of the combination therapy.
Experts opinion
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IVUS vs Angiography in patients with peripheral vascular disease

Dr Konstantinos Stavroulakis (St. Franziskus Hospital, Münster, DE) discusses Angiography alone in the lower limb - First results comparing IVUS and angiography in the leg. Questions : 1.What was the need for comparing IVUS and angiography in the leg? 2.What are your findings to date and what conclusions (if any) can be made? 3.What further data should be anticipated from the trial? 4.What further research, in your opinion, is needed? Source: https://www.radcliffevascular.com
Recorded video case

IVUS guided kissing endovascular lithoplasty and bare-metal-stent implantation for a coral reef aortic stenosis in visceral segment

Recorded case of a 72 yrs old woman with CLTI (Rutherford V,  TASC D lesion), not suitable for open repair, treated in a hybrid setting with IVUS guided kissing endovascular lithoplasty and bare-metal-stent implantation for a coral reef aortic stenosis in visceral segment, with a stent-graft for the right CIA and bare-metal-stent for the right CEA for the iliac high-grade stenosis and a femorofemoral bypass.

May 14, 2020 No Comments
Case report

Anterior tibial artery revascularization with piercing technique.

This case report was previously published in CLIC LATAM course in 2019.

We report case of a 60-year-old male patient with a history of hypertension and diabetes mellitus who currently has critical limb ischemia of the left foot with rest pain and trophic disorders at second and third toes and the forefoot. (WIfI 122 classification).

Angiography showed occlusion of both tibial arteries.

Due to the high risk of amputation, it was decided to continue with angioplasty of both tibial arteries.

Strategy:

Ultra-sound guided puncture of the left common femoral artery.

5 Fr sheath placement.

CXI support catheter.

V-14 and V-18 guidewires.

Conventional balloon angioplasty.

Endoluminal and antegrade revascularization with balloon angioplasty of the posterior tibial artery was performed without complications.

The anterior tibial artery could not be recanalized anterogradely with the V-14 guide, so a V-18 guide was used. Once the V-18 guidewire was located in the dorsalis pedis artery, an unsuccessful attempt was made to progress the CXI catheter to be able to exchange the 0.018” guide for a 300 cm 0.014” guide and perform balloon angioplasty due to the severe calcification of the vessel. A piercing technique was performed by fracturing arterial calcium with the percutaneous puncture of the vessel with an 18G puncture needle at the ankle level. Then, the progression of the  CXI catheter towards the dorsalis pedis artery is achieved and the exchange of guides is carried out to continue with balloon angioplasty. There were no complications secondary to the use of an aggressive technique such as “piercing” in this case, which carries a high risk of amputation without adequate revascularization.

May 3, 2020 2 Comments
Technical note

Recorded webinar – Percutaneous Venous Arterialization

Up to 20% of patients with Critical Limb Ischemia (CLI) are not considered good candidates for endovascular revascularization. If recanalization of a chronic occlusion of a BTK/ BTA artery proves to be impossible owing to the inability to cross an extensive occlusion or in the presence of a “desert foot”, percutaneous venous arterialization has proven to be a bailout strategy for limb salvage. Drs. August Ysa and Marta Lobato, from Vascular Surgery Dpt. Hospital de Cruces, Barakaldo (Spain), present the last update in Percutaneous Venous Arterialization technique and expose a Case in the box.

December 11, 2019 1 Comment
Basic vascular surgery skills

Knee Disarticulation (Major Amputation)

Unfortunately, sometimes happens that we can not save a leg with our interventions. Here only the amputation remains. In this short film from the series “Basic vascular surgery skills” – you can follow the individual steps for disarticulation in the knee joint as a major amputation of the lower leg.

November 8, 2019 No Comments
Technical note

Retrograde recanalisation of the peroneal. Step by step with tips and tricks

The peroneal artery often represents the last arterial supply to the foot. The retrograde puncture of this vessel is often avoided because of its deep location and its small diameter. In this video all the tricks to succeed are presented with a step by step approach and a mix of procedural and fluoroscopical imaging to better understand the procedure

September 13, 2019 No Comments
Recorded video case

Retrograde femoropopliteal recanalization through the dorsal pedal artery

This case demonstrates the recanalization of the femoropopliteal artery in a patient with CLTI. The reason for the solely retrograde approach was a Y-graft for AAA having the anastomoses at both common femoral arteries, the above-knee amputation of the contralateral limb and the extent of the disease. Primary stent implantation was performed by using the Pulsar-18 (Biotronik) bare-metal stent, which has a 4Fr profile and a proven efficacy according to the 4EVER trial.

July 14, 2019 No Comments
Recorded video case

TUTORIAL VIDEO: Venous arterialization using conventional “off-the-shelf” devices

Although we favor a more distal location of the AVF to circumvent the need to use covered stent extensions to destroy the valves and avoid bleeding off venous flow via collaterals, sometimes (e.g. due to extreme vessel calcification) it is unavoidable to have to look for a more proximal inflow. The versatility of the VAST maneuver allows to perform a proximal DVA at the origin of the PT artery with conventional off-the-shelf devices.”

JEVT 2019 Apr;26(2):213-218
JEVT 2019 Jun;26(3):427-428

July 7, 2019 1 Comment
Technical note

Retrograde access for tibioperoneal interventions: tips and tricks

Dr. Fadi Saab (Interventional cardiologist) demonstrates important technical steps for the optimization of tibioperoneal interventions in patients with critical limb-threatening ischemia (CLTI). In this video, you will find information about the steps of retrograde puncture, important tips, the explanation of CTOP classification and many other technical issues. Moreover, the experts discuss the feasibility and safety of retrograde puncture and share their experience on the CLTI treatment

January 20, 2019 No Comments
Live case

Two different techniques for retrograde infrainguinal CTO recanalization

This live case demonstrates two different techniques of retrograde recanalization: through collaterals of the CTO and through a retrograde tibial puncture. Moreover, you will see tips and tricks about the snaring of the wire and the further steps of such a procedure. Finally, the intervention was performed with CO2 angiography due to the chronic kidney disease of this patient suffering from chronic limb-threatening ischemia (CLTI).

November 26, 2018 No Comments