Percutaneous Deep Foot Vein Arterialization IVUS-Guided in No-Option Critical Limb Ischemia Diabetic Patients

Abstract

Purpose: To report our clinical experience with IVUS-guided percutaneous deep vein arterialization (pDVA) to treat chronic critical limb ischemia (cCLI) patients with no-endovascular or surgical options approach due to creation of an arteriovenous fistula (AVF). Materials and Methods: In a 2 years period, 14 no-option cCLI patients were treated with percutaneous deep vein arterialization (pDVA) by creating an AVF with a IVUS-guided system between posterior tibial artery and its satellite deep vein. Technical success was defined as successful AVF creation and venous perfusion of the wound site. Patients’ characteristics, procedure details, mortality and wound outcomes were assessed prospectively. Results: Successful pDVA was successfully performed in all patients (mean age 82 years) without any procedural complications. Clinical improvement was achieved in all patients with resolution of rest pain, tissue formation of granulation tissue or both; only 3 major amputations were performed within the study period with a limb salvage rate of 78%. Median wound healing time was 4.8 months. Conclusion: pDVA is a safe and feasible revascularization technique alternative in no-option cCLI patients.

Short-Term Outcomes and Efficacy of Percutaneous Deep Vein Arterialization for No-Option Critical Limb Ischemia: A Systematic Review and Meta-Analysis

“…This is, however, significantly lower than that reported by Ucci et al (2023) at 12 months (53.4% vs. 64.5%) [39]. The higher wound healing rate reported in the previous study arises from the higher wound healing estimates reported in the small case series included in the preset analysis [9,39,42]. However, it is important to note that this outcome is subject to large heterogeneity (I 2 = 78.53%, p-value = 0.001), which may be rooted in the different follow-up durations among the included studies.…”

Вплив Цукрового Діабету На Результати Стентування Та Балонної Ангіопластики У Хворих З Критичною Ішемією Нижніх Кінцівок

“…Актуальність проблеми визначення ефективних методів лікування стентування та балонної ангіопластики критичної ішемії нижніх кінцівок у хворих на ЦД було вивчено в роботах Lin [8], Majmundar [9], Darling [10,15], Popplewell [11], Conte [12], Suh [13], Surmann [14], Mayor [16], Choke [17], Lazaris [18], Campbell [19].…”

Single Center Outcomes of Percutaneous Deep Vein Arterialization in Patients with End-Stage Peripheral Artery Disease

“…17 Additionally, there is an increased risk of infection given distal stent graft placement and pedal access in an area high risk for infection. 18 Caution should be used in pDVA creation in patients with heart failure. 17,19 Overall, pDVA patients may have a prolonged hospital course, attributed to the severity of their illness and comorbidities.…”