Download PDF
Semin intervent Radiol 2023; 40(02): 183-192
DOI: 10.1055/s-0043-57264
Review Article

Deep Venous Arterialization: Background, Patient Selection, Technique, Outcomes and Follow-up, and Future Implementation

Naveed Zaman
1   Keck School of Medicine of the University of Southern California, Los Angeles, California
,
John Rundback
2   Advanced Interventional and Vascular Services, LLP, Teaneck, New Jersey
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Critical limb-threatening ischemia (CLTI) is a severe manifestation of peripheral arterial disease with a highly increased risk for morbidity and mortality that has limited and suboptimal opportunities for treatment, ultimately resulting in major amputation for patients. Deep venous arterialization (DVA) provides a suitable limb salvage option for “no-option” patients facing amputation by introducing an artificial anastomosis between a site of proximal arterial inflow and retrograde venous outflow to deliver tissue perfusion to lower extremity wounds. Because DVAs are employed as a last-resort effort in CLTI patients, it is important to provide updated information on indications for usage, strategies in creating DVA conduits, and discussion of outcomes and expectations for patients undergoing this procedure. Additionally, variations in method, including use of various techniques and devices, are explored. The authors provide an up-to-date review of the literature and discuss pertinent procedural and technical considerations for utilizing DVAs in CLTI patients.

Keywords

deep venous arterialization - chronic limb-threatening ischemia - peripheral arterial disease - endovascular therapy - interventional radiology


Publication History

Article published online:
16 June 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Conte SM, Vale PR. Peripheral arterial disease. Heart Lung Circ 2018; 27 (04) 427-432
    CrossrefPubMedSearch in Google Scholar
  • 2 Simon F, Oberhuber A, Floros N, Düppers P, Schelzig H, Duran M. Pathophysiology of chronic limb ischemia. Gefasschirurgie 2018; 23 (Suppl. 01) 13-18
    CrossrefPubMedSearch in Google Scholar
  • 3 Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG. TASC II Working Group. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg 2007; 45 (Suppl S ): S5-S67
    CrossrefPubMedSearch in Google Scholar
  • 4 Selvin E, Erlinger TP. Prevalence of and risk factors for peripheral arterial disease in the United States: results from the National Health and Nutrition Examination Survey, 1999-2000. Circulation 2004; 110 (06) 738-743
    CrossrefPubMedSearch in Google Scholar
  • 5 Uccioli L, Meloni M, Izzo V, Giurato L, Merolla S, Gandini R. Critical limb ischemia: current challenges and future prospects. Vasc Health Risk Manag 2018; 14: 63-74
    CrossrefPubMedSearch in Google Scholar
  • 6 Lee CY, Choi K, Kwon H. et al. Outcomes of endovascular treatment versus bypass surgery for critical limb ischemia in patients with thromboangiitis obliterans. PLoS One 2018; 13 (10) e0205305
    CrossrefPubMedSearch in Google Scholar
  • 7 Shoji K, Zen K, Yanishi K. et al. Two effective cases of additional pedal artery angioplasty for severe lower limb ischemia following acute thrombotic artery occlusion with hypercoagulable state diseases. CVIR Endovasc 2020; 3 (01) 71
    CrossrefPubMedSearch in Google Scholar
  • 8 Elbadawi A, Elgendy IY, Megaly M. et al. Temporal trends and outcomes of critical limb ischemia among patients with chronic kidney disease. Vasc Med 2021; 26 (02) 155-163
    CrossrefPubMedSearch in Google Scholar
  • 9 Hurst JE, Tehan PE, Hussey K, Woodburn J. Association of peripheral artery disease and chronic limb-threatening ischemia with socioeconomic deprivation in people with diabetes: a population data-linkage and geospatial analysis. Vasc Med 2021; 26 (02) 147-154
    CrossrefPubMedSearch in Google Scholar
  • 10 Grenon SM, Vittinghoff E, Owens CD, Conte MS, Whooley M, Cohen BE. Peripheral artery disease and risk of cardiovascular events in patients with coronary artery disease: insights from the Heart and Soul Study. Vasc Med 2013; 18 (04) 176-184
    CrossrefPubMedSearch in Google Scholar
  • 11 Roijers JJP, Rakké BYS, Hopmans NCJ. et al. Adverse cardiac events and mortality in patients with critical limb ischemia. Ann Vasc Surg 2020; 66: 486-492
    CrossrefPubMedSearch in Google Scholar
  • 12 Mustapha JA, Katzen BT, Neville RF. et al. Determinants of long-term outcomes and costs in the management of critical limb ischemia: a population-based cohort study. J Am Heart Assoc 2018; 7 (16) e009724
    CrossrefPubMedSearch in Google Scholar
  • 13 Dua A, Lee CJ. Epidemiology of peripheral arterial disease and critical limb ischemia. Tech Vasc Interv Radiol 2016; 19 (02) 91-95
    CrossrefPubMedSearch in Google Scholar
  • 14 Ferraresi R, Mauri G, Losurdo F. et al. BAD transmission and SAD distribution: a new scenario for critical limb ischemia. J Cardiovasc Surg (Torino) 2018; 59 (05) 655-664
    PubMedSearch in Google Scholar
  • 15 Ferraresi R, Ucci A, Pizzuto A. et al. A novel scoring system for small artery disease and medial arterial calcification is strongly associated with major adverse limb events in patients with chronic limb-threatening ischemia. J Endovasc Ther 2021; 28 (02) 194-207
    CrossrefPubMedSearch in Google Scholar
  • 16 David Smith C, Gavin Bilmen J, Iqbal S, Robey S, Pereira M. Medial artery calcification as an indicator of diabetic peripheral vascular disease. Foot Ankle Int 2008; 29 (02) 185-190
    CrossrefPubMedSearch in Google Scholar
  • 17 Losurdo F, Ferraresi R, Ucci A, Zanetti A, Clerici G, Zambon A. Association of infrapopliteal medial arterial calcification with lower-limb amputations in high-risk patients: a systematic review and meta-analysis. Vasc Med 2021; 26 (02) 164-173
    CrossrefPubMedSearch in Google Scholar
  • 18 Lew E, Nicolosi N, Botek G. Lower extremity amputation risk factors associated with elevated ankle brachial indices and radiographic arterial calcification. J Foot Ankle Surg 2015; 54 (03) 473-477
    CrossrefPubMedSearch in Google Scholar
  • 19 Chantelau E, Lee KM, Jungblut R. Distal arterial occlusive disease in diabetes is related to medial arterial calcification. Exp Clin Endocrinol Diabetes 1997; 105 (Suppl. 02) 11-13
    Thieme ConnectPubMedSearch in Google Scholar
  • 20 Ferraresi R, Ucci A, Casini A, Montero-Baker M. BAD and SAD-MAC: A New Scenario for CLTI. American College of Cardiology: ACC Publications; 2021
    Search in Google Scholar
  • 21 Torii S, Mustapha JA, Narula J. et al. Histopathologic characterization of peripheral arteries in subjects with abundant risk factors: correlating imaging with pathology. JACC Cardiovasc Imaging 2019; 12 (8, Pt 1): 1501-1513
    CrossrefPubMedSearch in Google Scholar
  • 22 Saab F, Jaff MR, Diaz-Sandoval LJ. et al. Chronic total occlusion crossing approach based on plaque cap morphology: the CTOP classification. J Endovasc Ther 2018; 25 (03) 284-291
    CrossrefPubMedSearch in Google Scholar
  • 23 Mustapha JA, Saab F, McGoff TN. et al. Chronic total occlusions: association between characteristics and mid-term outcomes in critical limb ischemia. J Crit Limb Ischem 2021; 1 (03) E95-E101
    PubMedSearch in Google Scholar
  • 24 Stavroulakis K, Borowski M, Torsello G, Bisdas T, Collaborators C. CRITISCH Collaborators. One-year results of first-line treatment strategies in patients with critical limb ischemia (CRITISCH Registry). J Endovasc Ther 2018; 25 (03) 320-329
    CrossrefPubMedSearch in Google Scholar
  • 25 Berger JS, Hiatt WR. Medical therapy in peripheral artery disease. Circulation 2022; 126: 491-500
    CrossrefPubMedSearch in Google Scholar
  • 26 Foley TR, Waldo SW, Armstrong EJ. Medical therapy in peripheral artery disease and critical limb ischemia. Curr Treat Options Cardiovasc Med 2016; 18 (07) 42
    CrossrefPubMedSearch in Google Scholar
  • 27 Chung J, Timaran DA, Modrall JG. et al. Optimal medical therapy predicts amputation-free survival in chronic critical limb ischemia. J Vasc Surg 2013; 58 (04) 972-980
    CrossrefPubMedSearch in Google Scholar
  • 28 Romiti M, Albers M, Brochado-Neto FC, Durazzo AE, Pereira CA, De Luccia N. Meta-analysis of infrapopliteal angioplasty for chronic critical limb ischemia. J Vasc Surg 2008; 47 (05) 975-981
    CrossrefPubMedSearch in Google Scholar
  • 29 Graziani L, Piaggesi A. Indications and clinical outcomes for below knee endovascular therapy: review article. Catheter Cardiovasc Interv 2010; 75 (03) 433-443
    CrossrefPubMedSearch in Google Scholar
  • 30 Weis-Müller BT, Römmler V, Lippelt I. et al. Critical chronic peripheral arterial disease: does outcome justify crural or pedal bypass surgery in patients with advanced age or with comorbidities?. Ann Vasc Surg 2011; 25 (06) 783-795
    CrossrefPubMedSearch in Google Scholar
  • 31 Ambler GK, Radwan R, Hayes PD, Twine CP. Atherectomy for peripheral arterial disease. Cochrane Database Syst Rev 2014; (03) CD006680
    PubMedSearch in Google Scholar
  • 32 Schmidt A, Ulrich M, Winkler B. et al. Angiographic patency and clinical outcome after balloon-angioplasty for extensive infrapopliteal arterial disease. Catheter Cardiovasc Interv 2010; 76 (07) 1047-1054
    CrossrefPubMedSearch in Google Scholar
  • 33 Faglia E, Clerici G, Clerissi J. et al. Angioplasty for diabetic patients with failing bypass graft or residual critical ischemia after bypass graft. Eur J Vasc Endovasc Surg 2008; 36 (03) 331-338
    CrossrefPubMedSearch in Google Scholar
  • 34 Meloni M, Giurato L, Izzo V, Stefanini M, Gandini R, Uccioli L. Risk of contrast induced nephropathy in diabetic patients affected by critical limb ischemia and diabetic foot ulcers treated by percutaneous transluminal angioplasty of lower limbs. Diabetes Metab Res Rev 2017; 33 (03)
    CrossrefPubMedSearch in Google Scholar
  • 35 Izzo V, Meloni M, Fabiano S. et al. Rearfoot transcutaneous oximetry is a useful tool to highlight ischemia of the heel. Cardiovasc Intervent Radiol 2017; 40 (01) 120-124
    CrossrefPubMedSearch in Google Scholar
  • 36 Kum S, Huizing E, Schreve MA. et al. Percutaneous deep venous arterialization in patients with critical limb ischemia. J Cardiovasc Surg (Torino) 2018; 59 (05) 665-669
    PubMedSearch in Google Scholar
  • 37 Sheil GR. Treatment of critical ischaemia of the lower limb by venous arterialization : an interim report. Br J Surg 1977; 64 (03) 197-199
    CrossrefPubMedSearch in Google Scholar
  • 38 Schreve MA, Minnee RC, Bosma J, Leijdekkers VJ, Idu MM, Vahl AC. Comparative study of venous arterialization and pedal bypass in a patient cohort with critical limb ischemia. Ann Vasc Surg 2014; 28 (05) 1123-1127
    CrossrefPubMedSearch in Google Scholar
  • 39 Francois-Franck M. Note a propos de la communication de M Raimond Petit sur la susture arterio-veneuse. Compt Rend Hebd Soc Biol 1896; 150
    PubMedSearch in Google Scholar
  • 40 Ho VT, Gologorsky R, Kibrik P. et al. Open, percutaneous, and hybrid deep venous arterialization technique for no-option foot salvage. J Vasc Surg 2020; 71 (06) 2152-2160
    CrossrefPubMedSearch in Google Scholar
  • 41 Nakabayashi K, Ando H, Kaneko N. et al. A novel lesion crossing technique: Balloon deployment using FORcible Manner (BADFORM) technique. Catheter Cardiovasc Interv 2017; 90 (07) 1161-1165
    CrossrefPubMedSearch in Google Scholar
  • 42 Gandini R, Merolla S, Scaggiante J. et al. Endovascular distal plantar vein arterialization in dialysis patients with no-option critical limb ischemia and posterior tibial artery occlusion: a technique for limb salvage in a challenging patient subset. J Endovasc Ther 2018; 25 (01) 127-132
    CrossrefPubMedSearch in Google Scholar
  • 43 Ichihashi S, Shimohara Y, Bolstad F, Iwakoshi S, Kichikawa K. Simplified endovascular deep venous arterialization for non-option CLI patients by percutaneous direct needle puncture of tibial artery and vein under ultrasound guidance (AV Spear Technique). Cardiovasc Intervent Radiol 2020; 43 (02) 339-343
    CrossrefPubMedSearch in Google Scholar
  • 44 Clair DG, Mustapha JA, Shishehbor MH. et al. PROMISE I: Early feasibility study of the LimFlow System for percutaneous deep vein arterialization in no-option chronic limb-threatening ischemia: 12-month results. J Vasc Surg 2021; 74 (05) 1626-1635
    CrossrefPubMedSearch in Google Scholar
  • 45 Kum S, Tan YK, Schreve MA. et al. Midterm outcomes from a pilot study of percutaneous deep vein arterialization for the treatment of no-option critical limb ischemia. J Endovasc Ther 2017; 24 (05) 619-626
    CrossrefPubMedSearch in Google Scholar
  • 46 Huizing E, Schreve MA, Kum S. et al. Development of a prediction model for the occurrence of stenosis or occlusion after percutaneous deep venous arterialization. Diagnostics (Basel) 2021; 11 (06) 1008
    CrossrefPubMedSearch in Google Scholar
  • 47 Zaman NS, Shackles C, Moriarty KT, Herman K, Rundback JH. Patterns of failure in deep venous arterialization and implications for management. J Crit Limb Ischem 2022; 2 (03) E58-E63
    PubMedSearch in Google Scholar
  • 48 Schmidt A, Schreve MA, Huizing E. et al. Midterm outcomes of percutaneous deep venous arterialization with a dedicated system for patients with no-option chronic limb-threatening ischemia: the ALPS Multicenter Study. J Endovasc Ther 2020; 27 (04) 658-665
    CrossrefPubMedSearch in Google Scholar
  • 49 HT VR, Nath L. New concepts in the management of ischaemic lower extremities. International Angiology: a Journal of the International Union of Angiology 1990; 9 (02) 97-104
    PubMedSearch in Google Scholar
  • 50 Wu ZQ, Jiang XP, Wu ZP. et al. Experimental and clinical studies on one-stage arterialization of the venous channels for revascularization of severely ischemic limbs. Chin Med J (Engl) Nov 1993; 106 (11) 814-20
    PubMedSearch in Google Scholar
  • 51 Lengua F, Cohen R, L'Huillier B, Buffet JM. Arteriovenous revascularization for lower limb salvage in unreconstructible arterial occlusive disease (long-term outcome). Vasa 1995; 24 (03) 261-9
    PubMedSearch in Google Scholar
  • 52 Mätzke S, Pitkänen J, Lepäntalo M. Does saphenous vein arterialisation prevent major amputation in critical leg ischaemia? A comparative study. J Cardiovasc Surg (Torino) Dec 1999; 40 (06) 845-7
    PubMedSearch in Google Scholar
  • 53 Taylor RS, Belli AM, Jacob S. Distal venous arterialisation for salvage of critically ischaemic inoperable limbs. Lancet Dec 04 1999;354(9194):1962–1965. Doi: 10.1016/s0140-6736(99)03164-5
    PubMed
  • 54 Engelke C, Morgan RA, Quarmby JW, Taylor RS, Belli AM. Distal venous arterialization for lower limb salvage: angiographic appearances and interventional procedures. Radiographics 2001 Sep-Oct 2001;21(05):1239–1248; discussion 1248-50.
    CrossrefPubMed
  • 55 Gavrilenko AV, Skrylev SI. Long-term results of venous blood flow arterialization of the leg and foot in patients with critical lower limb ischemia. Angiol Sosud Khir 2007; 13 (02) 95-103
    PubMedSearch in Google Scholar
  • 56 Busato CR, Utrabo CAL, Gomes RZ. et al. The great saphenous vein in situ for the arterialization of the venous arch of the foot. Jornal Vascular Brasileiro 2010; 9: 119-123
    PubMedSearch in Google Scholar
  • 57 Lengua F, Madrid AL, Acosta C, Vargas J. Temporal venous arterialization of the diabetic foot. Jornal Vascular Brasileiro 2010; 9: 14-20
    CrossrefPubMedSearch in Google Scholar
  • 58 Alexandrescu V, Ngongang C, Vincent G, Ledent G, Hubermont G. Deep calf veins arterialization for inferior limb preservation in diabetic patients with extended ischaemic wounds, unfit for direct arterial reconstruction: preliminary results according to an angiosome model of perfusion. Cardiovasc Revasc Med 2011 Jan-Feb 2011; 12 (01) 10-9
    CrossrefPubMedSearch in Google Scholar
  • 59 Djoric P. Early individual experience with distal venous arterialization as a lower limb salvage procedure. Am Surg Jun 2011; 77 (06) 726-30
    CrossrefPubMedSearch in Google Scholar
  • 60 Mutirangura P, Ruangsetakit C, Wongwanit C, Sermsathanasawadi N, Chinsakchai K. Pedal bypass with deep venous arterialization: the therapeutic option in critical limb ischemia and unreconstructable distal arteries. Vascular Dec 2011; 19 (06) 313-9
    CrossrefPubMedSearch in Google Scholar
  • 61 Djoric P, Zeleskov-Djoric J, Stanisavljevic DM. et al. Distal venous arterialization and reperfusion injury: focus on oxidative status. Eur Surg Res 2012; 48 (04) 200-7
    CrossrefPubMedSearch in Google Scholar
  • 62 Houlind K, Christensen J, Hallenberg C, Jepsen JM. Early results from an angiosome-directed open surgical technique for venous arterialization in patients with critical lower limb ischemia. Diabet Foot Ankle 2013; 4
    CrossrefPubMedSearch in Google Scholar
  • 63 Mustapha JA, Saab FA, Clair D, Schneider P. Interim Results of the PROMISE I Trial to Investigate the LimFlow System of Percutaneous Deep Vein Arterialization for the Treatment of Critical Limb Ischemia. J Invasive Cardiol 03 2019; 31 (03) 57-63
    PubMedSearch in Google Scholar