Related Experiment Video

Updated: Aug 22, 2026

A Multicenter MRI Protocol for the Evaluation and Quantification of Deep Vein Thrombosis
10:26

A Multicenter MRI Protocol for the Evaluation and Quantification of Deep Vein Thrombosis

Published on: June 2, 2015

A Hemodynamic Scoring System for Optimizing Transcatheter Arterialization of the Deep Veins in No-Option Patients

Michael C Siah1, Syed Muhammad Mashhood Ali Bokhari1, Anahita Dua2

  • 1Division of Vascular Surgery, UT Southwestern Medical Center, Dallas, Texas.

Journal of the Society for Cardiovascular Angiography & Interventions
|August 21, 2026
PubMed

Insights

A new Transcatheter Arterialization of the Deep Veins (TADV) scoring system helps select optimal crossing sites for chronic limb-threatening ischemia (CLTI) patients. This tool correlates with reduced pain and lower amputation risk, improving outcomes.

Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Medical Imaging

Background:

  • Transcatheter arterialization of the deep veins (TADV) is an emerging revascularization strategy for high-risk chronic limb-threatening ischemia (CLTI).
  • Variability in TADV outcomes necessitates structured tools for optimizing arteriovenous crossing-site selection and perfusion.
  • An angiographic scoring system is proposed to quantify the hemodynamic impact of donor artery selection in TADV procedures.

Purpose of the Study:

  • To develop and evaluate an angiographic TADV scoring system.
  • To quantify the hemodynamic impact of donor artery selection in TADV.
  • To assess the association between the TADV score and clinical outcomes in CLTI patients.

Main Methods:

  • Retrospective analysis of 43 patients from the PROMISE II trial with Rutherford class 5-6 CLTI.
  • Calculation of a TADV score (-4 to +4) based on pre- and postprocedural angiograms, integrating arterial contribution and crossing-site selection.
  • Assessment of primary outcome (pain reduction) and secondary outcomes (limb salvage, amputation-free survival, wound healing) using regression analyses.

Main Results:

  • 100% technical success with significant pain reduction from 5.1 to 1.4 at 2 years.
  • At 2 years, limb salvage was 60.7%, amputation-free survival 35.9%, and wound healing 62.5%.
  • The TADV score demonstrated high reliability (ICC 91.7%) and correlated with reduced pain and major amputation risk.

Conclusions:

  • The angiographic TADV score is a reliable tool for quantifying hemodynamic impact in TADV procedures.
  • The TADV score correlates with early pain reduction and reduced risk of major amputation in CLTI patients.
  • This scoring system can potentially optimize crossing-site selection and improve outcomes for no-option CLTI patients.
Abstract

Keywords:
chronic limb-threatening ischemialimb salvagetranscatheter arterialization of the deep veins

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