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Percutaneous approach to deep vein arterialization for the "no-option" chronic limb-threatening ischemia patient

Jayne R Rice1, Brett C Chatman1, Elizabeth A Genovese1

  • 1University of Pennsylvania, Penn Medicine, 3400 Civic Center Boulevard, PCAM 14 South, Philadelphia, PA 19104.

Seminars in Vascular Surgery
|March 14, 2025
PubMed

Insights

Deep venous arterialization offers a promising alternative to amputation for chronic limb-threatening ischemia (CLTI) patients. This approach aids limb salvage through careful patient selection and specialized care.

Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Peripheral Artery Disease Management

Background:

  • Chronic limb-threatening ischemia (CLTI) is an advanced stage of peripheral artery disease (PAD).
  • "No-option" CLTI patients historically faced limited treatment options, primarily major amputation.
  • Venous arterialization presents a novel alternative for limb salvage in challenging CLTI cases.

Purpose of the Study:

  • To review the historical context and evolution of venous arterialization techniques.
  • To outline patient selection criteria for deep venous arterialization (DVA).
  • To discuss percutaneous DVA techniques and postoperative management for limb salvage.

Main Methods:

  • Review of historical data and current literature on venous arterialization.
  • Description of percutaneous deep venous arterialization (DVA) surgical techniques.
  • Analysis of patient selection, multidisciplinary team support, and postoperative care strategies.

Main Results:

  • Deep venous arterialization (DVA) has demonstrated encouraging outcomes for long-term limb salvage.
  • Optimized technology and endovascular techniques have improved DVA efficacy.
  • Successful limb preservation is contingent upon meticulous patient selection and comprehensive care.

Conclusions:

  • Deep venous arterialization (DVA) is a viable and promising treatment for "no-option" CLTI patients.
  • Multidisciplinary collaboration is crucial for managing DVA maturation and wound healing.
  • Effective postoperative surveillance and reintervention strategies are key to sustained limb salvage.

Keywords:
Chronic limb threatening ischemiaDeep venous arterializationNo-option CLTIPeripheral arterial diseaseVenous arterialization

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