Simultaneous percutaneous transmural arterial bypass and deep venous arterialization for treatment of critical limb ischemia.

Inflow and outflow are the foundational principles of vascular surgery. This especially holds true in patients with peripheral arterial disease with chronic limb-threatening ischemia, who have a long segment occlusion of the superficial femoral artery and infrageniculate disease with inadequate distal targets for a bypass. Percutaneous transmural arterial bypass (PTAB) has demonstrated excellent results the endovascular management of femoropopliteal occlusive disease. However, without adequate outflow, the PTAB will not stay patent. Deep venous arterialization has shown promise in patients with inadequate outflow to the foot. Herein, we describe the first known experience of concomitant PTAB and deep venous arterialization to treat CTLI.