1. Management of Aortic and Aortoiliac Stenoses and Occlusions
During teh next 15 min I will try to explain my personal point of view, my vision in relation to the role of the cardiologist in the peripheral field.
Since I started to work within the EuroPCR, i am trying to bring the cardiologist into ,better back to teh peripheral field.
D. Scheinert, MD
Center of Vascular Medicine – Angiology and Vascular Surgery
Park Hospital Leipzig, Germany

2. Disclosure Statement of Financial Interest
Within the past 12 months, I or my spouse/partner have had a financial interest/arrangement or affiliation with the organization(s) listed below.
Minnow Medical Consultant
Lutonix Consultant
Atheromed Consultant
Angioscore Consultant
Cook Medical Consultant
Invatec Medtronic Consultant
Ev3 Consultant
IDEV Techn. Stockholder
Abbott Advisory Board
Boston Scientific Advisory Board
Cordis Advisory Board
Novostent Advisory Board
Angioslide Advisory Board
Gardia Medical Advisory Board
Revascular Therapeutics Advisory Board
I took this from a presentation at LINC – needs review

3. Standard Technique for Iliac PTA and Stenting: Retrograde approach

4. Alternative Technique for Iliac PTA and Stenting: Cross-over approach
Preferred technique stenoses and occlusions of the external iliac artery
allows multilevel interventions (iliac + femoral)
Easier puncture (better pulse)

5. Chronic Total Occlusion of the left CIA – Recanalization Techniques -
Retrograde Approach
Brachial Approach
Cross-over Approach

6. Chronic Total Occlusion of
the left CIA
Retrograde Approach
Potential Disadvantages:
Difficult puncture
Inability to re-enter the true
lumen in the area of the
aortic bifurcation

7. Problem of Retrograde Iliac Recanalization

8. Problem of Retrograde Iliac Recanalization
0.035“ Terumo stiff angled

9. Often less
calcified

10. Our Experience in Iliac CTO`s:
Antegrade recanalization in cross-over or transbrachial technique tends to have the highest success rates!

11. Occlusion of the right common iliac
Retrograde recanalization failed

12. Cross-over Recanalization
Shepherd
Hook
Hook

13. Retrograde Stent Implantation

15. Recanalization of iliac occlusions
Patients: n=211
Localization:
A. iliaca communis n=
A. iliaca externa n=
Aa. Iliacae comm. et ext. n=
Mean length of occlusion 8.6 cm
Technical Success n= %
Scheinert et al. Am J Med 2001, 110:708-15

16. Common Iliac Artery Occlusions Preferred Technique: Transbrachial
Brachial Approach
Left brachial access
6F Sheath 90 cm
Recanalization with stiff
hydrophilic wire (Terumo)

17. Transbrachiale Rekanalisation
Success rate: of 157 occlusions (96,8%)

18. Risk of Occluding the Hypogastric Artery
After double approach
and kissing-stent

19. Alternative: Retrograd Reca + Outback
Failure to renter at the bifurcation

21. Reentry-Device for Iliac CTOs
Outback-catheter

28. Endovascular Treatment of Aorto-Iliac Occlusions

30. Endovascular Treatment of Aorto-Iliac Occlusions

31. Conclusion
Interventional recanalization with primary stenting is the first line option for a variety of complex aorto-iliac obstructions incl. occlusions and bifurcation lesions.