Off-the-shelf Percutaneous Deep Vein Arterialization (pDVA)

Peripheral artery disease (PAD) affects up to 10% of people older than 50 years in Western Europe and North America, of which the worst clinical spectrum being chronic limb-threatening ischemia (CLTI). It is estimated that up to 20% of patients with CLTI are deemed un-reconstructable cases due to the absence of a suitable distal target vessel or conduit. Recently, percutaneous deep vein arterialization (pDVA) of the foot has been described to treat these patients. Technically arterialization of the deep foot veins is achieved by creating a communication between one of the tibial arteries with the deep veins in the foot. The Limflow system (Inari Medical TM) is the only CE-approved device for this technique. The PROMISE I, II, and UK provided the evidence to back the use of the Limflow system. Because of the limited availability and high cost of the LimFlow System, several studies have reported various off-the-shelf techniques described by authors attempting to achieve pDVA using alternative devices. In this review, we looked at some technical aspects of off-the-shelf pDVA and examine the outcomes in terms of technical success rates, wound healing rates, amputation free survival rates and re-interventions in comparison to those reported after the use of the Limflow system.