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Published on: September 22, 2020
Percutaneous Deep Venous Arterialization for Severe Critical Limb Ischemia in Patients With No Option of
C Del Giudice1, D Van Den Heuvel2, J Wille3
1Vascular and Oncological Interventional Radiology, Hôpital Européen Georges-Pompidou, Université Paris Descartes Paris Cité Sorbonne, 20 Rue Leblanc, 75015, Paris, France. costantino.delgiudice@gmail.com.
Insights
Fully percutaneous deep venous arterialization (pDVA) offers a safe option for chronic critical limb ischemia (cCLI) when other treatments fail. This technique shows promise in improving wound healing and limb salvage for no-option patients.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Regenerative Medicine
Background:
- Chronic critical limb ischemia (cCLI) presents a significant challenge, especially in patients with no distal targets for revascularization.
- Failed prior endovascular attempts necessitate novel treatment strategies for limb salvage.
Purpose of the Study:
- To evaluate the initial safety and feasibility of fully percutaneous deep venous arterialization (pDVA).
- To assess pDVA as a treatment for cCLI in patients with previously failed interventions.
Main Methods:
- pDVA was performed by creating an arteriovenous fistula between a below-knee artery and a deep vein.
- Patient selection included those with failed revascularization attempts and no distal targets.
- Outcomes assessed prospectively included technical success, limb events, cardiovascular complications, and wound healing.
Main Results:
- Successful pDVA was achieved in all five patients without procedural complications.
- No 30-day major adverse limb or cardiovascular events occurred.
- Sixty percent (3/5) of patients showed clinical improvement, including pain resolution and wound healing, with a median healing time of 39 weeks.
Conclusions:
- Fully percutaneous deep venous arterialization (pDVA) is a safe and feasible revascularization option for end-stage CLI.
- A multidisciplinary approach, including dedicated wound care, is crucial for optimal outcomes in cCLI management.
Purpose:
To report our initial experience of fully percutaneous deep venous arterialization (pDVA) for the treatment of chronic critical limb ischemia (cCLI) after failed distal angioplasty.
Materials And Methods:
pDVA was performed in five consecutive patients by creating an arteriovenous fistula (AVF) between a below the knee artery and its satellite deep vein. In this early experience, only patients with failed prior interventional attempts at establishing flow with no distal targets for an arterial bypass were selected. Early technical success was defined as successful AVF creation and retrograde venous perfusion of the wound site. Patient demographics, procedural details, morbidity/mortality and wound healing outcomes were assessed prospectively. Patients were followed up in wound care centers, and graft patency was documented on duplex ultrasound.
Results:
All five consecutive patients (mean age 58 years) underwent successful pDVA without any procedural complications. There were neither 30-day major adverse limb events nor major cardiovascular complications. Three out of the five patients (60%) had clinical improvement as observed by resolution of rest pain and complete wound healing. At the 1-month FU, one patient died and one patient received a major amputation. The median wound healing time was 39 weeks.
Conclusion:
pDVA is a safe and feasible vascularization alternative in patients with end-stage/no-option CLI. The early experience highlights the need for a multidisciplinary approach including a dedicated wound care service.
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