A 70-year-old male presents with basilic vein transposition with significant bleeding and decannulation. Dr. Steerman performs balloon angioplasty with Conquest PTA Balloon Dilatation Catheter, skillfully avoiding the need for a stent, thereby preserving the option for a future graft placement.
This patient is a seven year old male. He has a basilica vein transposition. Um That's uh a, a nice size, even though it's a medial lie, it's uh nice and close to the skin. He's had a significant bleeding with decannulation. Um So we're here a little stick in a sting here, my friend. Um Now we, he clearly has a symptom of peripheral stenosis. Um He doesn't have any arm swelling, sticking a little pressure. So, and some back pressure. So we're really, really going to be looking in the peripheral segment, um peripheral to the central venous circulation for evidence of stenosis that could be causing the problem. He has a pulsatile access too. Um But again, no, no real central symptoms. Let's see what we find tying up the symptoms to. Um the lesion helps us figure out what's humanly significant, what's symptomatic um because we don't want to treat things that aren't causing problems and that's, that's clearly the issue right there. Can I have a, let's go with the nine balloon, please. This is the uh central basilic vein. It's uh it's away from the cannulation zone. So this is an area uh that can be stinted. So, uh so this area we can tell is out of the cannulation zone. Um The cannulation zone is um from the insertion point of the sheath, not even the tip of the sheet all the way down to the insertion point. Uh to right about where my hemostats, I'd say, I don't think it's reasonable to cannulate any f or high into the axilla. So, since we're away from the cannulation zone, II, I think a stent would be reasonable. It wouldn't surprise me if this wouldn't respond too well. Um, to balloon angioplasty. Really in basilic vein. Some people talk about two swing, two swing points, uh One at the peripheral aspect, um and one in the central, nice job crossing that lesion. All right. Let's see what it does with the angioplasty. Go on, sir. You may feel a little bit of pressure right around your armpit. Yeah. And that came up pretty easy. Which begs the question. Is this a soft plaque that's gonna recoil after the balloon comes down. We'll see, we'll see what we see. We'll give it a little bit of time to equilibrate and then come back down if we had to stent. Um You definitely would want to use something in a flare configuration. Um, probably a nine or a 10 by uh 5060. As we're, as we're thinking through things come on down. I'm saying that partially for your benefit and not partially for, for efficiency. In the room. Go up again, please. So, while we're considering our options, we're checking our inventory to see what's available and what can be used looks like it's coming down a little bit. Mm. I always try to be moving. I'm hooking up my injector as we're waiting for the balloon to take a basement. Come on down, please. Uh, we'll pull that out and let's see what we have. So we've got some residual stenosis right here. It, it is drastically better. Um I think ballooning it. Um Another time may make sense. Let's try that again. Go ahead for uh those of you who do do other peripheral interventions. Um We uh we, we try not to equilibrate this to another circuit. Um You know, we as vascular surgeons, we do lots of interventions to the superficial femoral artery in the thigh. Um And sort of the mantra there is balloon, balloon, balloon, try not to leave a stent, try not to do anything um that, that could jail further options in the future. And, and we know that's different in the fish. And I think it's the wrong thing to treat the fistula as a superficial femoral artery. Um There are some areas where we know you get better patency with placing a stent. The venus and assis is, is the key area. Um where stents really make the most sense. There isn't a lot of good data for this area of the central Basilic Maine we, we know technically that it's out of the cannulation zone, so it won't cause problems there. Come on down, please. Um And up again, um I think uh conceptually it, it makes sense. Um And it's a safe place to put it. You don't jail alternatives in the future. Um But um actually in in this position you would because if you extended that stent into the axillary vein, um you wouldn't be able to place a graft peripheral to that if you'd had an impaired flow. OK. Come on down. Um But without really good data, I my approach has been to treat this with uh balloon angioplasty and, and have a low threshold to stent to, to get a good result. Um But, um, I don't treat it the same as the Venus and Timos where I know first time out through we're gonna get the best result if we stent, I think that's a reasonably good result. I think, I think that's a very good result. In fact, um, and that way by avoiding a stent, we have the potential to put a graft in for the future. So we're gonna pull out here. OK.
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