Management of the no-option foot: Deep vein arterialization

Abstract

The incidence of peripheral artery disease continues to rise worldwide, with a concomitant rise in the subset of patients who manifest with chronic limb-threatening ischemia (CLTI). A mainstay of CLTI treatment is revascularization through open surgical bypass, endovascular therapy, or hybrid approaches combining the two modalities. However, a significant proportion of these patients are considered to have nonreconstructable, or no-option, CLTI. This is related to either significant pedal arterial occlusive disease or lack of a bypass conduit. Deep vein arterialization has been used as a potential treatment option for this cohort of patients. We explore the various described methodologies of deep vein arterialization, including open, hybrid, and totally percutaneous. These studies suggest that deep vein arterialization is a promising treatment paradigm for patients with no-option CLTI, with encouraging results in terms of technical feasibility, wound healing, and ultimately limb salvage. However, further study of appropriate patient selection, standardization of techniques, and long-term follow-up are needed.