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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.
VASA. Zeitschrift Fur Gefasskrankheiten
|September 19, 2025
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.
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.
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