C Del Giudice1, D Van Den Heuvel2, J Wille3, T Mirault4, E Messas4, R Ferraresi5, S Kum6, M Sapoval7. 1. Vascular and Oncological Interventional Radiology, Hôpital Européen Georges-Pompidou, Université Paris Descartes Paris Cité Sorbonne, 20 Rue Leblanc, 75015, Paris, France. costantino.delgiudice@gmail.com. 2. Department of Interventional Radiology, St Antonius Hospital, Nieuwegein, The Netherlands. 3. Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, The Netherlands. 4. Department of Vascular Medicine, Hôpital Européen Georges Pompidou, Université Paris Descartes Paris Cité Sorbonne, 20 Rue Leblanc, 75015, Paris, France. 5. Peripheral Interventional Unit, Humanitas Gavazzeni, Bergamo, Italy. 6. Vascular Service, Department of Surgery, Changi General Hospital, Changi, Singapore. 7. Vascular and Oncological Interventional Radiology, Hôpital Européen Georges-Pompidou, Université Paris Descartes Paris Cité Sorbonne, 20 Rue Leblanc, 75015, Paris, France.
Abstract
PURPOSE: To report our initial experience of fully percutaneous deep venous arterialization (pDVA) for the treatment of chronic critical limb ischemia (cCLI) after failed distal angioplasty. MATERIALS AND METHODS: pDVA was performed in five consecutive patients by creating an arteriovenous fistula (AVF) between a below the knee artery and its satellite deep vein. In this early experience, only patients with failed prior interventional attempts at establishing flow with no distal targets for an arterial bypass were selected. Early technical success was defined as successful AVF creation and retrograde venous perfusion of the wound site. Patient demographics, procedural details, morbidity/mortality and wound healing outcomes were assessed prospectively. Patients were followed up in wound care centers, and graft patency was documented on duplex ultrasound. RESULTS: All five consecutive patients (mean age 58 years) underwent successful pDVA without any procedural complications. There were neither 30-day major adverse limb events nor major cardiovascular complications. Three out of the five patients (60%) had clinical improvement as observed by resolution of rest pain and complete wound healing. At the 1-month FU, one patient died and one patient received a major amputation. The median wound healing time was 39 weeks. CONCLUSION: pDVA is a safe and feasible vascularization alternative in patients with end-stage/no-option CLI. The early experience highlights the need for a multidisciplinary approach including a dedicated wound care service.
PURPOSE: To report our initial experience of fully percutaneous deep venous arterialization (pDVA) for the treatment of chronic critical limb ischemia (cCLI) after failed distal angioplasty. MATERIALS AND METHODS: pDVA was performed in five consecutive patients by creating an arteriovenous fistula (AVF) between a below the knee artery and its satellite deep vein. In this early experience, only patients with failed prior interventional attempts at establishing flow with no distal targets for an arterial bypass were selected. Early technical success was defined as successful AVF creation and retrograde venous perfusion of the wound site. Patient demographics, procedural details, morbidity/mortality and wound healing outcomes were assessed prospectively. Patients were followed up in wound care centers, and graft patency was documented on duplex ultrasound. RESULTS: All five consecutive patients (mean age 58 years) underwent successful pDVA without any procedural complications. There were neither 30-day major adverse limb events nor major cardiovascular complications. Three out of the five patients (60%) had clinical improvement as observed by resolution of rest pain and complete wound healing. At the 1-month FU, one patient died and one patient received a major amputation. The median wound healing time was 39 weeks. CONCLUSION: pDVA is a safe and feasible vascularization alternative in patients with end-stage/no-option CLI. The early experience highlights the need for a multidisciplinary approach including a dedicated wound care service.
Authors: Beau M Hawkins; Jun Li; Luke R Wilkins; Teresa L Carman; Amy B Reed; David G Armstrong; Philip Goodney; Christopher J White; Aaron Fischman; Marc L Schermerhorn; Dmitriy N Feldman; Sahil A Parikh; Mehdi H Shishehbor Journal: Vasc Med Date: 2022-04-25 Impact factor: 4.739