Department of Radiology, Tan Tock Seng Hospital, Singapore.
Tokyo Bay Medical Center, Tokyo, Japan.
J Endovasc Ther. 2024 Jun;31(3):350-359. doi: 10.1177/15266028221127850. Epub 2022 Sep 28.
Chronic limb-threatening ischemia (CLTI) represents the clinical end stage of lower extremity peripheral arterial disease (PAD). Although conventional open and endovascular revascularization options are available, some CLTI patients do not respond to these treatments, generally due to small vessel occlusive disease, with only limited or no clinical improvement achieved. This article aims to provide insights related to pertinent venous anatomy of the leg and below the ankle and a technical review of percutaneous deep venous arterialization (pDVA) creation using commonly-available devices.
For patients with "no-option" CLTI, the risk of major amputation and mortality remains high. Although arterial revascularization remains the optimal treatment of CLTI, some patients with severely-diseased or gracile distal arteries have poor outcome. Deep venous arterialization (DVA), in a subset of patients with tibial anatomy amenable to DVA creation, represents the last-ditch attempt before these patients are deemed to have "no-hope" at limb salvage, and major amputation becomes necessary. Refinement in technique and advancement in device development have been shown to allow pDVA to be created with respectable outcomes for the "no-option" CLTI patient population.
The pDVA has garnered increasing interest among endovascular specialists to further understand the anatomical and technical key points of this procedure, and it may yet prove to be a useful addition in the armamentarium in our battle against CLTI.
Percutaneous deep venous arterialisation provides another option in the treatment of challenging "no-option" CLTI patients, and off-the-shelf devices will allow this procedure to be performed in centers where dedicated devices are not available.
慢性肢体威胁性缺血（CLTI）代表下肢外周动脉疾病（PAD）的临床终末阶段。虽然有传统的开放和血管内血运重建选择，但一些 CLTI 患者对这些治疗没有反应，通常是由于小血管闭塞性疾病，只有有限的或没有临床改善。本文旨在提供与腿部和踝关节以下相关静脉解剖结构的相关见解，并对使用常用设备进行经皮深静脉动脉化（pDVA）创建的技术进行综述。
对于“无选择”CLTI 患者，大截肢和死亡率的风险仍然很高。尽管动脉血运重建仍然是 CLTI 的最佳治疗方法，但一些严重病变或细小远端动脉的患者预后较差。深静脉动脉化（DVA）在适合 DVA 创建的胫骨解剖结构的患者亚组中，是这些患者被认为没有肢体挽救希望并需要大截肢之前的最后一次尝试。技术的改进和设备的发展进步已经表明，pDVA 可以为“无选择”CLTI 患者群体创造令人尊敬的结果。
pDVA 在血管内专家中引起了越来越多的兴趣，以进一步了解该手术的解剖学和技术要点，并且它可能在我们对抗 CLTI 的斗争中被证明是一种有用的附加手段。
经皮深静脉动脉化在治疗具有挑战性的“无选择”CLTI 患者方面提供了另一种选择，并且现成的设备将允许在没有专用设备的情况下在中心进行该手术。
