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Evidence for transcatheter arterialization of deep veins in poor-option chronic limb-threatening ischemia: A

Mounika Naidu Boya1, Isabella Ferlini Cieri1, Adriana A Rodriguez Alvarez1

  • 1Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA.

Journal of Vascular Surgery
|October 24, 2025
PubMed

Insights

Transcatheter arterialization of deep veins (TADV) significantly improves limb salvage and amputation-free survival in no-option chronic limb-threatening ischemia (CLTI) patients. This minimally invasive procedure offers a transformative solution for those ineligible for traditional treatments.

Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Regenerative Medicine

Background:

  • Chronic limb-threatening ischemia (CLTI) in no-option patients carries a high risk of major amputation (up to 67% at 1 year).
  • Transcatheter arterialization of deep veins (TADV) shows promise, but comparative data against standard-of-care (SoC) is limited.

Purpose of the Study:

  • To compare the efficacy of Food and Drug Administration-approved TADV procedures with SoC treatments in no-option CLTI patients.
  • To evaluate limb salvage rates, amputation-free survival, and technical success of TADV versus SoC.

Main Methods:

  • Systematic literature search (PubMed, Embase, 2015-2025) for TADV studies in Rutherford class 5/6 CLTI patients.
  • Comparison with a natural history study cohort (n=180) of no-option CLTI patients managed with conventional strategies (SoC).
  • Analysis of primary endpoint: limb salvage rates at 12 months.

Main Results:

  • Limb salvage rates were significantly higher in the TADV cohort (79.6%) compared to the SoC cohort (55.1%) at 12 months (P < .001).
  • Amputation-free survival was superior in TADV patients (71.0%) versus SoC (37.3%) (P < .001).
  • Technical success rate for TADV procedures was high at 97.6%.

Conclusions:

  • TADV offers substantially superior limb salvage and amputation-free survival compared to SoC in no-option CLTI patients.
  • TADV represents a transformative advancement for managing this high-risk patient population.
  • Improved wound healing is also noted with TADV treatment.
Abstract

Keywords:
AmputationDeep vein arterializationLimb salvageNo-option chronic limb-threatening ischemiaStandard of careTranscatheter deep vein arterializationVascular diseasesWound healing

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