Saab Fadi A, Mustapha Jihad A, Ansari Mohammad, Pupp Guy, Madassery Kumar, N'Dandu Zola, Wiechmann Bret N, Bernstein Rick, Mize Abigail, Pliagas George
Advanced Cardiac and Vascular Centers for Amputation Prevention, Grand Rapids, Michigan.
Texas Tech University Health Sciences Center, Lubbock, Texas.
J Soc Cardiovasc Angiogr Interv. 2022 Aug 27;1(6):100437. doi: 10.1016/j.jscai.2022.100437. eCollection 2022 Nov-Dec.
Percutaneous deep venous arterialization (pDVA) is a minimally invasive technique connecting the tibial arteries below the knee to the tibial venous system into plantar venous circulation to deliver oxygenated blood to otherwise nonperfused foot. This study demonstrated outcomes of pDVA with commercially available equipment and described single-center experience on pDVA for critical limb-threatening ischemia patients with small artery diseases and end-stage plantar disease (ESPD) who were deemed no-option cases.
A single-center retrospective review was performed on patients who underwent pDVA. Primary end points were successful establishment of tibial vein flow with venous pedal loop, rate of major amputation, and major adverse events over 6 months. Secondary end points were primary and secondary patency rates, minor amputation rates, and wound healing over 6 months.
Forty-two patients with ESPD underwent pDVA. Risk factors identified were hypertension (92.8%), hyperlipidemia (85.7%), diabetes (78.6%), tobacco abuse (42.9%), and chronic kidney disease ≥ stage 3 (42.8%). Three patients were categorized as Rutherford Class 4, 14 patients Class 5, and 25 patients (59.5%) Class 6. Of 42 procedures, 33 (78.6%) were deemed successful. Amputation-free survival at 6 months was reported in 25 patients (60.9%); 16 patients (38.1%) reported minor amputations. Wound healing rate reported at 6 months was 23.8%.
This is one of the largest case series to date with real-world no-option patients undergoing pDVA. pDVA seems a reasonable option for limb salvage in patients with ESPD where traditional arterial revascularization is not feasible. Identifying criteria for patient selection and advanced wound care is important to ensure clinical success. Additional research is required to establish diagnostic guidelines for patients being evaluated for pDVA.
经皮深静脉动脉化（pDVA）是一种微创技术，将膝下胫动脉与胫静脉系统相连，进入足底静脉循环，为原本无灌注的足部输送含氧血液。本研究展示了使用市售设备进行pDVA的结果，并描述了在单中心对患有小动脉疾病和终末期足底疾病（ESPD）且被视为无其他选择的严重肢体缺血患者进行pDVA的经验。
对接受pDVA的患者进行单中心回顾性研究。主要终点为通过静脉足环成功建立胫静脉血流、大截肢率以及6个月内的主要不良事件。次要终点为初次和二次通畅率、小截肢率以及6个月内的伤口愈合情况。
42例ESPD患者接受了pDVA。确定的危险因素包括高血压（92.8%）、高脂血症（85.7%）、糖尿病（78.6%）、吸烟（42.9%）以及慢性肾病≥3期（42.8%）。3例患者被归类为卢瑟福分级4级，14例为5级，25例（59.5%）为6级。在42例手术中，33例（78.6%）被视为成功。25例患者（60.9%）报告6个月时无截肢存活；16例患者（38.1%）报告进行了小截肢。6个月时报告的伤口愈合率为23.8%。
这是迄今为止对接受pDVA的现实世界中无其他选择患者的最大病例系列之一。对于传统动脉血运重建不可行的ESPD患者，pDVA似乎是保肢的合理选择。确定患者选择标准和先进的伤口护理对于确保临床成功很重要。需要进一步研究以建立对接受pDVA评估患者的诊断指南。
