Takagi Tomonari, Miyamoto Akira, Ohura Norihiko, Yamauchi Yasutaka
Cardiovascular Center, Takatsu General Hospital, 1-16-7 Mizonokuchi, Takatsu-Ku, Kawasaki-Shi, Kanagawa, 213-0001, Japan.
Department of Plastic and Reconstructive Surgery, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka-Shi, Tokyo, 181-8611, Japan.
Cardiovasc Intervent Radiol. 2025 Feb;48(2):244-250. doi: 10.1007/s00270-024-03871-1. Epub 2024 Oct 7.
This retrospective, single-center study aimed to determine the efficacy of percutaneous deep venous arterialization in patients on hemodialysis with chronic limb-threatening ischemia.
Twenty-one consecutive limbs on hemodialysis with chronic limb-threatening ischemia were treated with percutaneous deep venous arterialization using balloon angioplasty following a failed pedal arterial reconstruction between May 2021 and June 2022. An arteriovenous fistula near the ankle joint was created to ensure sufficient venous flow reversal to the pedal veins. In case of occlusion of the tibial artery, a guidewire was advanced (subintimal) to the ankle joint vicinity was technically important. The primary outcome measures were the 6-month complete wound healing and freedom from major amputation rates; the secondary outcome measure was the 6-month amputation-free survival.
Occlusion of all pedal arteries was observed in 17 limbs (81.0%). Arteriovenous fistulas were predominantly created at the distal portions of the posterior tibial artery and vein in 18 limbs (85.7%). No extravasation at the fistulas was observed. Re-intervention was required in 16 limbs (76.2%) due to tibial artery or deep vein occlusion. The 6-month complete wound healing rate was 42.9% (nine limbs), with a median healing time of 85 days (interquartile range: 58-151 days). The 6-month freedom from major amputation and amputation-free survival rates were 90.5% (19 limbs) and 61.9% (13 limbs), respectively.
Balloon angioplasty without stent implantation for percutaneous deep venous arterialization is promising for improving the complete wound healing and amputation-free survival rates after pedal artery reconstruction failure.
Level 3b, retrospective cohort study.
本回顾性单中心研究旨在确定经皮深静脉动脉化对患有慢性肢体威胁性缺血的血液透析患者的疗效。
2021年5月至2022年6月期间，对21例患有慢性肢体威胁性缺血的血液透析患者的连续肢体进行了经皮深静脉动脉化治疗，在足背动脉重建失败后采用球囊血管成形术。在踝关节附近建立动静脉瘘，以确保有足够的静脉血流逆向流入足背静脉。在胫动脉闭塞的情况下，将导丝（内膜下）推进到踝关节附近在技术上很重要。主要观察指标为6个月时伤口完全愈合和免于大截肢率；次要观察指标为6个月时无截肢生存率。
17例肢体（81.0%）观察到所有足背动脉闭塞。18例肢体（85.7%）主要在胫后动脉和静脉的远端建立了动静脉瘘。未观察到瘘口处有渗漏。16例肢体（76.2%）因胫动脉或深静脉闭塞需要再次干预。6个月时伤口完全愈合率为42.9%（9例肢体），中位愈合时间为85天（四分位间距：58 - 151天）。6个月时免于大截肢和无截肢生存率分别为90.5%（19例肢体）和61.9%（13例肢体）。
经皮深静脉动脉化采用无支架植入的球囊血管成形术对于改善足背动脉重建失败后的伤口完全愈合率和无截肢生存率很有前景。
3b级，回顾性队列研究。
