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Simultaneous percutaneous transmural arterial bypass and deep venous arterialization for treatment of critical limb

Vashisht Madabhushi1, Eleanor Dunlap1, Khanjan Nagarsheth1

  • 1Division of Vascular Surgery, Department of Surgery, University of Maryland Medical Center, Baltimore, MD.

Journal of Vascular Surgery Cases and Innovative Techniques
|March 6, 2025
PubMed

Insights

This study introduces a novel approach for chronic limb-threatening ischemia (CTLI) by combining percutaneous transmural arterial bypass (PTAB) with deep venous arterialization, addressing challenges in vascular surgery for patients with poor outflow. This innovative technique aims to improve outcomes for complex peripheral arterial disease cases.

Area of Science:

  • Vascular Surgery
  • Endovascular Interventions
  • Ischemia Management

Background:

  • Peripheral arterial disease (PAD) with chronic limb-threatening ischemia (CTLI) presents challenges due to long segment occlusions and inadequate distal targets.
  • Effective vascular surgery relies on both inflow and outflow, critical for bypass patency.
  • Existing endovascular techniques like percutaneous transmural arterial bypass (PTAB) show promise but require adequate outflow.

Observation:

  • Deep venous arterialization has emerged as a potential solution for patients with insufficient outflow to the foot.
  • This study reports the first known combined use of PTAB and deep venous arterialization.

Findings:

  • Concomitant PTAB and deep venous arterialization were successfully employed to treat CTLI.
  • This combined approach addresses the critical need for both inflow and outflow in complex femoropopliteal occlusive disease.

Implications:

  • This novel strategy offers a new treatment option for patients with severe PAD and CTLI who were previously untreatable.
  • Further research into this combined technique could significantly advance the management of limb ischemia.
  • Improved limb salvage rates are anticipated with the successful application of this combined endovascular approach.

Keywords:
DETOURDVADeep vein arterializationPTABPercutaneous transmural arterial bypass

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