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Updated: Sep 20, 2025

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Management of the no-option foot: Deep vein arterialization

Sadia Ilyas1, Richard J Powell1

  • 1Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756.

Seminars in Vascular Surgery
|June 7, 2022
PubMed

Insights

Deep vein arterialization offers a promising solution for chronic limb-threatening ischemia (CLTI) patients with no viable surgical options. This technique shows potential for limb salvage in challenging peripheral artery disease cases.

Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Regenerative Medicine

Background:

  • Peripheral artery disease (PAD) and chronic limb-threatening ischemia (CLTI) incidence is increasing globally.
  • Standard revascularization methods (bypass, endovascular) are not suitable for all CLTI patients, termed 'no-option' CLTI.
  • Deep vein arterialization (DVA) is an emerging treatment for no-option CLTI.

Purpose of the Study:

  • To review and explore various deep vein arterialization methodologies for no-option CLTI.
  • To assess the efficacy and potential of DVA in limb salvage for complex PAD cases.

Main Methods:

  • Review of existing literature on open, hybrid, and totally percutaneous deep vein arterialization techniques.
  • Analysis of reported outcomes including technical feasibility, wound healing, and limb salvage rates.

Main Results:

  • Deep vein arterialization demonstrates technical feasibility across different approaches.
  • Encouraging results reported for wound healing and limb salvage in patients with no-option CLTI.
  • The technique shows promise as a viable treatment option for previously untreatable CLTI.

Conclusions:

  • Deep vein arterialization is a promising treatment for no-option CLTI, offering hope for limb salvage.
  • Further research is required for patient selection, technique standardization, and long-term outcome evaluation.
  • DVA represents a significant advancement in managing complex peripheral artery disease cases.

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