Related Experiment Video
Updated: Sep 8, 2025
Synergizing Antegrade Endoscopic with Bridging Vein Harvesting for Improvement of Great Saphenous Vein Graft Quality from the Lower Leg
Published on: November 19, 2019
Early experience with venous arterialization for limb salvage in no-option patients with chronic limb-threatening
Jorge A Miranda1, Zachary Pallister1, Sherene Sharath1
1Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
Insights
Venous arterialization (VA) offers a viable limb salvage option for chronic limb-threatening ischemia (CLTI) patients when conventional revascularization fails. This study shows VA achieves an 81% limb salvage rate at one year in select CLTI cases.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Regenerative Medicine
Background:
- Chronic limb-threatening ischemia (CLTI) presents significant challenges, with a subset of patients lacking conventional revascularization options.
- Venous arterialization (VA) emerges as a potential limb salvage strategy for these complex cases.
Purpose of the Study:
- To review the outcomes of venous arterialization (VA) at a single institution for patients with CLTI.
- To evaluate the feasibility and effectiveness of VA in achieving limb salvage.
Main Methods:
- A prospective review of 41 patients who underwent superficial or deep VA was conducted.
- Data included demographics, comorbidities, VA technique (endovascular vs. hybrid), WIfI limb staging, and outcomes (patency, wound healing, limb events, amputation, death) at 1, 6, and 12 months.
Main Results:
- At 1 year, VA achieved 67% secondary patency, 46.3% overall wound healing, and an 81% limb salvage rate.
- Major adverse limb events occurred in 36.5% of patients, including 17% major amputations.
- Four deaths (19%) occurred within 6 months, two attributed to COVID-19; no further deaths by 1 year.
Conclusions:
- Superficial and deep VA are feasible options for limb salvage in select CLTI patients with high WIfI stage and no conventional revascularization options.
- VA can provide a critical alternative for limb preservation when other methods are exhausted.
Objective:
Chronic limb-threatening ischemia (CLTI) is associated with adverse limb outcomes and increased mortality. However, a small subset of the CLTI population will have no feasible conventional methods of revascularization. In such cases, venous arterialization (VA) could provide an alternative for limb salvage. The objective of the present study was to review the outcomes of VA at our institution.
Methods:
We performed a single-institution review of 41 patients who had been followed up prospectively and had undergone either superficial or deep VA. The data collected included patient demographics, comorbidities, VA technique (endovascular vs hybrid), and WIfI (wound, ischemia, and foot infection) limb staging. Data were collected at 1-month, 6-month, and 1-year intervals and included the following outcomes: patency, wound healing, major adverse limb events, major amputation, and death. Descriptive statistics were used for analysis.
Results:
The study group included 41 patients who had undergone successful open hybrid superficial or deep endovascular VA; 21 (51.2%) had undergone a purely endovascular procedure and 20 (48.8%), hybrid VA. The WIfI clinical stage was as follows: stage 4, 33 (80.5%); stage 3, 6 (14.6%); and stage 2, 1 (2.4%). Of the 41 patients, 24 (58.5%) had completed follow-up at 6 months and 16 (39%) at 1 year. At 1 year, the VA primary patency was 28.6% (95% confidence interval [CI], 0.15%-0.43%), primary assisted patency was 44.3% (95% CI, 0.27%-0.60%), and secondary patency was 67% (95% CI, 0.49%-0.80%). The complete wound healing rate was 2.7% (n = 1) at 1 month, 62.5% (n = 15) at 6 months, and 18.8% (n = 3) at 1 year. Overall wound healing at 1 year was 46.3% (n = 19). The number of major adverse limb events at 1 year was 15 (36.5%) and included 8 reinterventions (19.5%) and 7 major amputations (17%). The number of deaths was zero (0%) at 1 month and four (19%) at 6 months. Two deaths (9.5%) were attributed to COVID-19 (coronavirus disease 2019). No further deaths had occurred within 1 year. The limb salvage survival probability at 1 year was 81%.
Conclusions:
These findings suggest that for a select subset of CLTI patients presenting with a high WIfI clinical limb stage and no viable options for conventional open or endovascular arterial revascularization, superficial and deep VA are feasible options to achieve limb salvage.
Related Concept Videos
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:30Venous Thrombosis IV: Nursing Management
01:27Peripheral Artery Disease III: Interprofessional Care
01:29Venous Thrombosis III: Interprofessional Care
01:15Veins of Lower Limbs
Formed by the union of the medial and lateral plantar veins, the posterior tibial vein, rising through the calf muscle, assimilates the fibular vein. The anterior tibial vein, a superior extension of the foot's dorsalis pedis vein, merges with the posterior tibial vein at the...
01:25Hemodialysis I: Introduction