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Related Experiment Video

Updated: Jun 20, 2026

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Percutaneous in situ venous arterialisation.

Nicolaus Reifart¹

¹Main Taunus Heart Institute, Bad Soden, Germany. n.reifart@reifart-partner.de

Eurointervention : Journal of Europcr in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology

|September 9, 2009

Summary

Percutaneous in situ venous arterialisation (PICVA) offers a new approach for patients with diffuse coronary disease. This catheter-based technique aims to restore blood flow to the heart muscle, providing a potential option for previously untreatable cases.

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Area of Science:

Cardiovascular Medicine
Interventional Cardiology
Biomedical Engineering

Background:

Approximately 5% of patients annually lack viable therapeutic options due to diffuse coronary artery disease.
Traditional treatments like angioplasty, stenting, and bypass surgery are not feasible when there's no discrete target.
Retrograde myocardial perfusion via the venous system has historical precedent in surgical approaches for "ungraftable" patients.

Purpose of the Study:

To evaluate the feasibility and safety of Percutaneous in situ venous arterialisation (PICVA) as a novel catheter-based coronary bypass technique.
To assess PICVA's potential as a therapeutic option for patients with diffuse coronary disease and no other treatment alternatives.

Main Methods:

PICVA utilizes unique catheter-based devices to create an arterialised segment of a coronary vein.
This arterialised vein segment facilitates retrograde perfusion of ischaemic myocardium.
The study involved the first eleven percutaneous applications of this catheter-based coronary bypass in human patients within the PICVA European Safety trial.

Main Results:

The study demonstrated the feasibility of the PICVA technique in highly symptomatic patients with limited therapeutic options.
Despite challenges, including two deaths and six instances where a connection could not be established, the procedure showed potential.
Pre-clinical animal studies indicated that PICVA could reduce ischaemia and myocardial damage in infarction models.

Conclusions:

Percutaneous in situ venous arterialisation (PICVA) represents a potentially viable, albeit early-stage, catheter-based approach for coronary bypass.
Further development of this veno-arterial coronary bypass technique is warranted for inoperable and undilatable patients.
PICVA may offer a future therapeutic avenue for a subset of patients with complex coronary artery disease currently lacking treatment options.