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

Ahmad Naga1, Noor Hamo2, Chloe Lakin2

  • 1Department of Vascular Surgery, Guy's and St Thomas' NHS Foundation trust, UK and Alexandria University, Egypt.

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Summary

Peripheral artery disease (PAD) and chronic limb-threatening ischemia (CLTI) impact many older adults. This review explores off-the-shelf percutaneous deep vein arterialization (pDVA) techniques as an alternative to the LimFlow system for treating unreconstructable CLTI cases.

Keywords:
Chronic limb-threatening ischemiaLimb salvageOff-the-shelf percutaneous deep vein arterializationPeripheral arterial diseases

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Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Endovascular Therapies

Background:

  • Peripheral artery disease (PAD) affects over 10% of individuals over 50, with chronic limb-threatening ischemia (CLTI) representing its most severe form.
  • Up to 20% of CLTI patients are unsuitable for traditional revascularization due to lack of target vessels.
  • Percutaneous deep vein arterialization (pDVA) offers a novel endovascular approach for CLTI by creating an arterial-venous connection in the foot.

Purpose of the Study:

  • To review and compare the technical aspects and clinical outcomes of off-the-shelf pDVA techniques.
  • To evaluate the efficacy of alternative devices for pDVA against the established LimFlow system.
  • To assess success rates, wound healing, amputation-free survival, and re-intervention rates for off-the-shelf pDVA.

Main Methods:

  • Review of published literature on off-the-shelf percutaneous deep vein arterialization (pDVA) techniques.
  • Analysis of technical success, wound healing, amputation-free survival, and re-intervention data.
  • Comparative assessment against outcomes reported for the LimFlow system.

Main Results:

  • Off-the-shelf pDVA techniques are being explored due to the cost and limited availability of the LimFlow system.
  • Data on technical success, wound healing, and amputation-free survival for off-the-shelf pDVA are emerging.
  • Comparative outcomes between off-the-shelf devices and the LimFlow system require further investigation.

Conclusions:

  • Off-the-shelf pDVA presents a viable alternative for treating unreconstructable CLTI patients.
  • Further research is needed to establish the long-term efficacy and safety of various off-the-shelf pDVA approaches.
  • Standardization and comparative studies are crucial for optimizing pDVA strategies in CLTI management.