A Novel Technique to Create an Arteriovenous Fistula During Total Percutaneous Deep Foot Venous Arterialisation Using an IVUS Guided Catheter

Migliara, Bruno; Cappellari, Tania Francesca

doi:10.1016/j.ejvs.2018.02.031

Cited by 17 publications

(11 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Alternate techniques of venous arterialization have been reported. [23][24][25] In these studies, the arteriovenous fistula was created as distal in the tibial artery as possible. Technical success varied from 77% to 100%, with clinical success rates from 29% to 75% at various time points.…”

Section: Discussionmentioning

confidence: 99%

Midterm Outcomes of Percutaneous Deep Venous Arterialization With a Dedicated System for Patients With No-Option Chronic Limb-Threatening Ischemia: The ALPS Multicenter Study

et al. 2020

View full text Add to dashboard Cite

Purpose: To evaluate the midterm results of patients suffering from no-option chronic limb-threatening ischemia (CLTI) treated with a dedicated system for percutaneous deep venous arterialization (pDVA). Materials and Methods: Thirty-two consecutive CLTI patients (mean age 67±14 years; 20 men) treated with pDVA using the Limflow device at 4 centers between 11 July 2014 and 11 June 2018 were retrospectively analyzed. Of all patients, 21 (66%) had diabetes, 8 (25%) were on immunosuppression, 4 (16%) had dialysis-dependent renal failure, 9 (28%) had Rutherford category 6 ischemia, and 25 (78%) were deemed at high risk of amputation. The primary outcome was amputation-free survival (AFS) at 6 months. Secondary outcomes were wound healing, limb salvage, and survival at 6, 12, and 24 months. Results: Technical success was achieved in 31 patients (96.9%). The median follow-up was 34 months (range 16–63). At 6, 12, and 24 months, estimates were 83.9%, 71.0%, and 67.2% for AFS, 86.8%, 79.8% and 79.8% for limb salvage, and 36.6%, 68.2%, and 72.7% for complete wound healing, respectively. Median time to complete wound healing was 4.9 months (range 0.5–15). The DVA circuit occluded during follow-up in 21 patients; the median time to occlusion was 2.6 months. Reintervention for occlusion was performed in 17 patients: 16 because of unhealed wounds and 1 for a newly developed ulcer. Conclusion: This study represents the largest population of patients with no-option CLTI treated with pDVA using the LimFlow device with midterm results. In this complex group of patients, pDVA using the LimFlow device has been shown to be feasible, with a high technical success rate and AFS at 6 up to 24 months coupled with wound healing. In selected patients with no-option CLTI, pDVA could be a recommended treatment to prevent amputation and heal wounds.

show abstract

Section: Discussionmentioning

confidence: 99%

Midterm Outcomes of Percutaneous Deep Venous Arterialization With a Dedicated System for Patients With No-Option Chronic Limb-Threatening Ischemia: The ALPS Multicenter Study

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Although scarcely mentioned by the authors, other approaches for proximal pDVA (PIPER), 3 distal pDVA, 4 and the venous arterialization simplified technique (VAST) 5,6 have also consistently achieved equivalent results both for limb salvage and wound healing. 7 These alternative maneuvers should not be dismissed because the majority of the physicians are currently performing their pDVA procedures using these techniques owing to the limited availability and increased cost of the Limflow device.…”

mentioning

confidence: 99%

Commentary: Percutaneous Venous Arterialization: Should We Contain Our Enthusiasm?

Ysa

2020

J Endovasc Ther

View full text Add to dashboard Cite

The outcomes of the ALPS study 1 published in the August 2020 issue of the JEVT are without doubt remarkable for a no-option chronic limb-threatening ischemia (CLTI) population. This retrospective multicenter study represents the largest population of patients (n=32) to date treated with percutaneous deep venous arterialization (pDVA) using the Limflow device (Limflow, Paris, France) with midterm results. The trial reports a 97% technical success rate, with limb salvage rates of 86.8%, 79.8%, and 79.8% at 6, 12, and 24 months, respectively, and corresponding complete wound healing rates of 36.6%, 68.2%, and 72.7%. These results are within the range for those previously reported by Mustapha et al 2 in the PROMISE I trial.Although scarcely mentioned by the authors, other approaches for proximal pDVA (PIPER), 3 distal pDVA, 4 and the venous arterialization simplified technique (VAST) 5,6 have also consistently achieved equivalent results both for limb salvage and wound healing. 7 These alternative maneuvers should not be dismissed because the majority of the physicians are currently performing their pDVA procedures using these techniques owing to the limited availability and increased cost of the Limflow device.Despite these encouraging results, the exact mechanism of action of pDVA remains unclear. It has been suggested that the use of the venous bed as a conduit for perfusion successfully increases flow through existing hibernating collaterals, improves tissue perfusion and nutrition in the capillary beds, and stimulates angiogenesis. 2 As a result, DVA improves microvascularization in target skeletal muscles and reduces ischemic markers, with a reduction in venous lactate. 8 Moreover, in the ALPS trial 1 (as in other studies), TcPO 2 , a reliable predictor of wound healing, rose to significant levels 6 to 8 weeks after DVA (45 days postprocedure).At this time there are also several practical aspects to pDVA that generate controversy and remain unsolved. Below are a few of these questions.

show abstract

“…Dr Ysa had mentioned several other approaches to performing pDVA. Proximal pDVA using the Pioneer Plus catheter, 9 distal pDVA, 10 and the venous arterialization simplified technique (VAST) 11 are being discussed as alternative techniques with equivalent results for both limb salvage and wound healing. Furthermore, it is stated that these techniques should be taken into consideration because of limited availability and increased costs of the LimFlow device.…”

mentioning

confidence: 99%

“…Furthermore, it is stated that these techniques should be taken into consideration because of limited availability and increased costs of the LimFlow device. Although we acknowledge the importance of discussing different techniques for pDVA, we believe it is difficult to compare the results of a multicenter cohort of 32 patients with single-center case series of 7 patients 9,10 and 5 patients 11 utilizing various devices and techniques. In addition, we would like to underline that the cost of using the Pioneer Plus catheter with Viabahn stents 9 is significant as well.…”

mentioning

confidence: 99%

“…Although we acknowledge the importance of discussing different techniques for pDVA, we believe it is difficult to compare the results of a multicenter cohort of 32 patients with single-center case series of 7 patients 9,10 and 5 patients 11 utilizing various devices and techniques. In addition, we would like to underline that the cost of using the Pioneer Plus catheter with Viabahn stents 9 is significant as well. Also, the distal pDVA and VAST techniques are complex maneuvers that have yet to be reproduced in other studies, and their applicability in the hands of most operators is as yet unknown.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Reply to “More Data Are Needed to Elucidate the Achilles’ Heel of Percutaneous Deep Venous Arterialization”

et al. 2020

View full text Add to dashboard Cite

A Novel Technique to Create an Arteriovenous Fistula During Total Percutaneous Deep Foot Venous Arterialisation Using an IVUS Guided Catheter

Cited by 17 publications

References 0 publications

Midterm Outcomes of Percutaneous Deep Venous Arterialization With a Dedicated System for Patients With No-Option Chronic Limb-Threatening Ischemia: The ALPS Multicenter Study

Midterm Outcomes of Percutaneous Deep Venous Arterialization With a Dedicated System for Patients With No-Option Chronic Limb-Threatening Ischemia: The ALPS Multicenter Study

Commentary: Percutaneous Venous Arterialization: Should We Contain Our Enthusiasm?

Reply to “More Data Are Needed to Elucidate the Achilles’ Heel of Percutaneous Deep Venous Arterialization”

Contact Info

Product

Resources

About