Abstract
In 42 limbs of 36 patients with severe pedal disease suffering from chronic limb-threatening ischemia (CLTI) , we performed percutaneous deep venous arterialization (pDVA)by conventional balloon angioplasty as an alternative to the LimFlow system, which has not yet been approved in Japan. Here, we report on the techniques used and outcomes achieved. The procedure involved first passing a wire through to the plantar veins and performing balloon dilation of the occluded tibial artery (usually the posterior tibial artery) up to the ankle joint to perfuse the foot veins with arterial blood. Then, we used the venous arterialization simplified technique to create a tibial arteriovenous fistula at the ankle. The cohort comprised of 94.4% dialysis patients, all of whom had wounds on their feet; 57.1% of the patients had Rutherford category 6. The procedure success rate was 100%, and no serious complications occurred. Except for two limbs that required bailout stents, all limbs were successfully treated by balloon dilation only. Although the one-year cumulative amputation-free survival rate was poor (47.0%) , only four limbs required major amputations, and the wound healing rate at one year was 56.0%. Our method of using only balloon angioplasty appears to be a viable option for pDVA.
