Deep venous arterialization in critical limb-threatening ischemia (CLTI): Case series and literature review

Abstract

Introduction

Chronic Limb-Threatening Ischemia (CLTI) represents a severe form of peripheral arterial disease characterized by ischemic rest pain, non-healing wounds, and/or gangrene. Deep Venous Arterialization (DVA) is an option when there is inadequate distal inline flow to allow for wound healing (No Option CLTI). There is a paucity of data on DVA; which prompted our interest in presenting our experience with DVA.

Methods

We performed a retrospective review on all patients undergoing DVA from January 2022 through February 2024. The procedure was indicated for patients with CLTI as a last resort for limb salvage. Patient demographics, surgical techniques, and postoperative variables were recorded. Outcomes included were mortality, time to wound healing, minor and major amputations. All other operative complications were also recorded.

Outcomes

There were eleven patients with a total of thirteen DVAs performed. Two DVAs were performed on the same limb. The mean age was 67.4 ± 11.3 years, with seven patients (63.6 %) being male. Comorbidities included were hypertension in nine (81.8 %), coronary artery disease in seven (63.6 %), hyperlipidemia in six (54.5 %), and type 2 diabetes mellitus in three (27.3 %) patients, respectively. At a median follow-up of 112.5 days (range: 76- 742 days), limb salvage was achieved in eight (66.7 %) and complete wound healing in four limbs (33.3 %). Seven (58.3 %) limbs required minor amputations. Four (33.3 %) limbs required major amputation including two (16.7 %) due to occluded bypass and two (16.7 %) due to uncontrolled infection. Two (18.2 %) deaths were recorded during the follow-up period.

Conclusion

DVA has acceptable short outcomes with good limb salvage and wound healing rates. Timing to achieve mobility with associated deconditioning, quality of life, and cost are areas to be explored in larger studies in comparison to those patients undergoing primary amputation with immediate rehabilitation.