A2VF Technique: Venous-Puncture-Free Foot Arteriovenous Fistula Creation in Chronic Limb-Threatening Ischemia

This study aimed to describe the antegrade arteriovenous fistula technique, an intravascular ultrasound-guided arterial approach for foot arteriovenous fistula creation without percutaneous venous puncture or venous sheath insertion.

In a patient with no-option chronic limb-threatening ischemia, intravascular ultrasound was used to identify a distal posterior tibial artery segment with a less calcified arterial wall window and an adjacent, visible posterior tibial vein. A hard-tip guidewire supported by a microcatheter was advanced from the artery into the vein, followed by guidewire navigation into the plantar venous arch, valvotomy, and venous tract dilatation.

Severe circumferential calcification, inadequate visualization of the target vein, and distal vessel angulation may limit technical success.

The antegrade arteriovenous fistula technique may remove the need for direct venous access during foot arteriovenous fistula creation in selected patients.