AB076. SOH25_AB_313. Deep venous arterialization as a limb salvage technique in critical limb ischemia

Background: Critical limb ischemia (CLI) represents the end stage of peripheral arterial disease (PAD), with severe limb-threatening ischemia that causes intense pain, numbness, and non-healing ulcers. In advanced cases where conventional revascularization is not possible, patients often face the prospect of major limb amputation. Deep venous arterialization (DVA) offers a promising alternative for these patients, creating an arteriovenous connection to revascularize ischemic tissues via the venous system. This presentation explores recent findings and case studies demonstrating the viability and effectiveness of DVA.

Methods: We reviewed three CLI cases with no revascularization options that were managed with either transcatheter or open DVA techniques. Notably, a recent multicenter study reported a 99% technical success rate, with a 66.1% amputation-free survival (AFS) at 6 months and significant rates of wound healing. Further, findings from the PROMISE II study and others show that DVA can extend limb viability, reduce amputation rates, and improve wound healing outcomes in high-risk patients.

Results: Our case studies highlight both the potential and challenges of DVA. Complications such as venous hypertension, thrombosis, and arterial steal syndrome remain concerns, with long-term patency of the arteriovenous connections still under investigation. Nevertheless, the DVA approach can serve as a critical option in limb preservation, providing a viable pathway for patients otherwise facing amputation.

Conclusions: DVA represents an innovative limb salvage strategy for CLI patients lacking traditional revascularization options. Continued research and clinical refinement of this technique are essential to improving patient outcomes and expanding access to this potentially life-altering intervention.

Keywords: Amputation; arterialization; bypass; complications; endovenous