Chapters Transcript Video Stenting of Venous Anastomosis with Covera™ Vascular Covered Stent Duration: 6:00 minutes This is an 84 year old female, um, with a brachial axillary AV graft that goes in a lateral position right here, a nice big loop, a nice big cannulation zone. Uh, she presents today with, um, high venous pressure and and venous circulation, uh, for a ficulogram just on exam this entire graph right here is very pulsatile, um, so, uh, we're expecting something central to this. She doesn't have arm edema, um, so I think it's less likely that's something central, um, that's symptomatic and we're gonna number up on the arterial limb. And place our access. You can see the um High back pressure. Um, With access right there. Consistent with he and I, uh, venous pressure. Um As is not uncommon, we have been unable to get a peripheral IV, um, and, uh, we have the option to do this under straight local or, um, if we're gonna do something a little bit more involved. We'll inject something through the sheath. Looks like a, uh, a generous graph that we have there, um, and, and due to the curve there, Covera would probably be the best stent for that area. Um, there's a size discrepancy between the graft and the vein, so I think something in a flared configuration, um. We've got a 960. I, I think that's reasonable, and that's, that's a flared Covera. So looking at our reference image, um, we have a couple of options about how we're gonna set this up. Um, the surgeon who placed this graph was very nice, uh, to leave some internal controls and internal ways of figuring out where the stenosis is. You can see there's about 6 clips or 8 clips right at that venous anastomosis, so we can use that as internal markers. The other option is to do a road map situation. You're just about ready, yep, um, to do a, a, a road map or or to mark the screen, I think with the clips that we have, we don't need to do either of those. So we'll push it in and then we'll pull it back a little bit to take some of the tension out of there. We have a little bit of oozing around there, just put a little bit of, I'm just putting a little bit of pressure over there. Um, we chose the 60 because we're gonna get completely through the curve of that venous anastomosis. We don't want to end our stent ever in a curve. Um, the lock is turned off. Um, I typically just use, um, the larger wheel. Um, what happens sometimes is you start to deploy the Covera. Is it can inch forward and you see that happening right there just often in inches forward, um, and then you pull it back just a little bit as you're deploying it. So with back pressure. And deploy it right there, continued back pressure through that curve segment and then we've got deployment right there completely. Can you walk that off please? And holding pressure right here. We still have some residual stenosis which speaks to incomplete angioplasty even though it was a properly sized um angioplasty balloon, um, and now we're gonna try to do some post, uh, stent dilatation. With our balloon, it's interesting to see that even though it was a short area of stenosis, we really did have to stent through that entire area, uh, to, to get a good result. I, I think anything shorter really, um, would have been a mistake and we would have regretted it. um, now while while I'm doing things, I, I do like to move fairly quickly putting a balloon through a fresh stent is one thing that I will do very slowly. Uh, we don't want it to get caught. And change the configuration, um, after we do our post, uh, balloon angioplasty, go ahead. Um, It will be um somewhat more adherent to that area and less likely to move. And take it all the way to burst there. On the OK, and down please. Um, the flare configuration is very nice. I use it pretty frequently when we have mismatched sized vessels such as this. And you can already see that we have better. Uh, effacement of that stent. Looks great. I mean that that really looks great. Very happy with the way the contrast is moving through that area. You can see on the ends of each stent that there's complete, uh, contact with the wall right there. Um, the stent isn't causing any sort of narrowing in one way or the other. The contrast to that area, both the opacification of the contrast and the clearing of contrast is very rapid, um, and I, I think that's a nice result. um, she shouldn't have any more problems. All right, we'll take everything out, put our stitch in. And we did that without any sedation, is that right? OK. Published January 10, 2025 Created by Related Presenters Samuel N. Steerman, MD Vascular Surgery View full profile