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Efficacy and Durability of Percutaneous Deep Vein Arterialization: A Systematic Review

Samuel E So1, Yiu Che Chan1, Stephen W Cheng1

  • 1Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong SAR, China.

Annals of Vascular Surgery
|April 5, 2024
PubMed

Insights

Endovascular deep vein arterialization (DVA) shows promise for no-option critical limb ischemia (NO-CLI) patients, with high technical success but significant amputation rates. Further research is needed to establish routine use.

Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Regenerative Medicine

Background:

  • Peripheral arterial disease (PAD) management remains challenging for patients ineligible for conventional surgery.
  • Endovascular deep vein arterialization (DVA) presents a novel approach for limb salvage in such cases.
  • This review synthesizes current evidence on DVA's efficacy and safety in no-option critical limb ischemia (NO-CLI).

Approach:

  • A systematic review adhering to PRISMA guidelines was conducted.
  • Searches included "percutaneous deep vein arterialization" and "percutaneous deep venous arterialization" across major databases.
  • Studies with ≥5 patients, excluding open or hybrid DVA, were analyzed for primary and secondary outcomes.

Key Points:

  • Ten studies with 233 NO-CLI patients were reviewed, with a median follow-up of 12 months.
  • Technical success rate reached 97%, with a major amputation rate of 21.8%.
  • Wound healing was observed in 69.5%, with complication, reintervention, and mortality rates at 13.8%, 37.4%, and 15.7%, respectively.

Conclusions:

  • Endovascular DVA appears safe for NO-CLI patients.
  • However, current studies are small and have limited follow-up (<1 year).
  • Level 1 evidence is lacking to support routine DVA implementation for NO-CLI.
Abstract

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