Single Center Outcomes of Percutaneous Deep Vein Arterialization in Patients with End-Stage Peripheral Artery Disease
Krystina N Choinski1, Ajit G Rao1, Prakash Krishnan2
1Division of Vascular Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Insights
Percutaneous deep vein arterialization (pDVA) offers a new option for critical limb ischemia in end-stage peripheral artery disease (PAD). This technique achieved 100% procedural success and 75% limb salvage in a small case series.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Regenerative Medicine
Background:
- Peripheral artery disease (PAD) can progress to chronic limb-threatening ischemia (CLTI), often leaving patients with no traditional revascularization options.
- Lack of pedal targets in advanced PAD necessitates innovative endovascular techniques.
- Percutaneous deep vein arterialization (pDVA) has emerged as a potential solution for CLTI in 'no option' patients.
Purpose of the Study:
- To describe the technique and outcomes of pDVA in four patients with end-stage PAD.
- To evaluate the technical success, complications, wound healing, and limb salvage rates following pDVA.
Main Methods:
- Retrospective chart review and follow-up of four patients undergoing pDVA for end-stage PAD.
- Analysis of technical success, post-procedural complications, wound healing, and freedom from major amputation.
Main Results:
- 100% technical success rate for pDVA procedures.
- 75% limb salvage rate, with three patients achieving successful wound healing.
- One patient required below-knee amputation (BKA) due to worsening ischemic breakdown despite re-intervention.
Conclusions:
- Percutaneous deep vein arterialization (pDVA) is a promising technique for restoring perfusion in the venous system for end-stage PAD patients.
- The case series demonstrates high procedural success and a significant limb salvage rate, supporting further exploration of pDVA.
- Continued research and utilization of pDVA are expanding treatment possibilities in the modern vascular era.
Abstract:
Background: Peripheral artery disease (PAD) can present as chronic limb threatening ischemia (CLTI) with ischemic pain and tissue loss. Progression of distal disease can lead to a "no option" or end-stage disease without traditional open or endovascular revascularization due to lack of pedal targets. Innovations in endovascular technology allow for the use of percutaneous deep vein arterialization (pDVA) to treat patients with CLTI. Purpose: We describe our experience and technique for treating four patients with end-stage PAD with pDVA. Research Design: Four patients with end-stage PAD were followed during and after pDVA creation. Technical success, complications, wound healing, and freedom from major amputation were analyzed. Data Collection and Analysis: Patient data and outcomes were collected via chart review and at time of follow up appointments in vascular surgery clinic. Results: Technical success was 100%, without post-procedural complications, and patients were continued on antiplatelet and anticoagulation. Three patients (75%) had successful wound healing, with 2 patients healing after transmetatarsal amputation (TMA), and 1 healing a distal foot ulceration that did not require surgery. One patient had worsening ischemic breakdown of a TMA, despite re-intervention on the pDVA, which required a below knee amputation (BKA). Freedom from major amputation was 75% overall, with an average follow-up time of 410 days post-procedure (Range: 113-563 days). Conclusions: Percutaneous deep vein arterialization attempts to provide blood flow to the preserved venous bed in patients with end-stage PAD. Exploration and utilization of this technique continues to expand in the modern vascular era. This case series highlights 4 patients with end-stage PVD who underwent pDVA, with 100% procedural success, and 75% limb salvage rate.
