Percutaneous Deep Venous Arterialization: Treatment of Patients with End-Stage Plantar Disease

• Published in: Journal of the Society for Cardiovascular Angiography & Interventions Vol. 1; no. 6; p. 100437
• Main Authors: Saab, Fadi A., Mustapha, Jihad A., Ansari, Mohammad, Pupp, Guy, Madassery, Kumar, N’Dandu, Zola, Wiechmann, Bret N., Bernstein, Rick, Mize, Abigail, Pliagas, George
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2022
• Subjects: amputation-free survival; critical limb ischemia; deep venous arterialization; end-stage plantar disease; no-option CLTI; small artery disease; CLTI; end-stage plantar disease; ESPD; deep venous arterialization; PT; small artery disease; DP; pDVA; DVA; amputation-free survival; EVUS; critical limb ischemia; AT; AV; no-option CLTI; SAD
• ISSN: 2772-9303; 2772-9303
• DOI: 10.1016/j.jscai.2022.100437

Percutaneous deep venous arterialization (pDVA) is a minimally invasive technique connecting the tibial arteries below the knee to the tibial venous system into plantar venous circulation to deliver oxygenated blood to otherwise nonperfused foot. This study demonstrated outcomes of pDVA with commercially available equipment and described single-center experience on pDVA for critical limb-threatening ischemia patients with small artery diseases and end-stage plantar disease (ESPD) who were deemed no-option cases. A single-center retrospective review was performed on patients who underwent pDVA. Primary end points were successful establishment of tibial vein flow with venous pedal loop, rate of major amputation, and major adverse events over 6 months. Secondary end points were primary and secondary patency rates, minor amputation rates, and wound healing over 6 months. Forty-two patients with ESPD underwent pDVA. Risk factors identified were hypertension (92.8%), hyperlipidemia (85.7%), diabetes (78.6%), tobacco abuse (42.9%), and chronic kidney disease ≥ stage 3 (42.8%). Three patients were categorized as Rutherford Class 4, 14 patients Class 5, and 25 patients (59.5%) Class 6. Of 42 procedures, 33 (78.6%) were deemed successful. Amputation-free survival at 6 months was reported in 25 patients (60.9%); 16 patients (38.1%) reported minor amputations. Wound healing rate reported at 6 months was 23.8%. This is one of the largest case series to date with real-world no-option patients undergoing pDVA. pDVA seems a reasonable option for limb salvage in patients with ESPD where traditional arterial revascularization is not feasible. Identifying criteria for patient selection and advanced wound care is important to ensure clinical success. Additional research is required to establish diagnostic guidelines for patients being evaluated for pDVA. [Display omitted] •Retrospective review of 42 percutaneous deep venous arterialization cases.•Outcomes were procedure success and amputation-free survival at 6 months.•Multiple modalities for AV fistula creation to perform pDVA are described.•Amputation-free survival at 6 months was reported in 60.9% of patients.•Mechanisms for failure and need for further data are discussed.