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DVA: Updated Evidence, Techniques, and Management Post-Intervention.

Shivraj Grewal¹, Shaan Haider², Sreekumar Madassery¹

¹Department of Vascular and Interventional Radiology, Rush University Medical Center, Chicago, IL.

Techniques in Vascular and Interventional Radiology

|March 13, 2026

Summary

Deep vein arterialization (DVA) offers a new revascularization option for critical limb ischemia patients with no other surgical choices. This technique shows promising results in improving blood flow and potentially reducing amputation rates in this challenging patient group.

Keywords:

Amputation CLI CLTI DVA Limb Salvage Limflo

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Area of Science:

Vascular Surgery
Interventional Cardiology
Limb Salvage Procedures

Background:

Critical limb-threatening ischemia (CLTI) patients often lack suitable vessels for traditional revascularization, leading to high amputation and mortality rates.
Deep vein arterialization (DVA) is an emerging strategy for 'no-option' CLTI patients with small vessel disease or a 'desert foot'.

Purpose of the Study:

To detail the indications, contraindications, and pre-operative assessment for DVA.
To describe various DVA approaches and post-procedural management strategies.
To review the technical challenges and reintervention commonalities associated with DVA.

Main Methods:

DVA involves creating a tibial artery-to-vein fistula for retrograde blood flow to the foot.
The procedure requires careful patient selection, pre-operative evaluation, and specific arterialization techniques.
Post-procedural management includes surveillance, reintervention, and multidisciplinary collaboration.

Main Results:

DVA can be technically demanding, especially with complex arterial inflow or venous anatomy.
Post-DVA reinterventions are common, addressing issues like graft occlusion, stenosis, or venous hypertension.
Growing evidence supports DVA efficacy and the benefits of early reintervention for no-option CLTI patients.

Conclusions:

Deep vein arterialization provides a viable revascularization option for previously untreatable CLTI patients.
Successful DVA requires meticulous technique, vigilant post-procedural management, and a multidisciplinary approach.
DVA demonstrates promising outcomes, offering hope for limb salvage in the most challenging ischemic limb cases.