Deep Vein Arterialization: Indications, Techniques, and Clinical Outcomes

1. Outline the indications for deep vein arterialization (DVA) in chronic limb-threatening ischemia (CLTI).


2. Illustrate techniques of transcatheter deep vein arterialization (DVA) through a case series.


3. Demonstrate appropriate post-procedural care and long-term clinical outcomes of deep venous arterialization (DVA).

Mortality rates following major amputation approximate 60% at 5 years, rivaling the rates of all cancers as a whole over the same time period. Despite advances in surgical and endovascular techniques, up to 20% of patients with chronic limb-threatening ischemia (CLTI) are deemed “no-option” patients: inappropriate for open or endovascular revascularization due to the absence of suitable target vessels. Deep vein arterialization (DVA) is an endovascular procedure that can be used as a last resort in patients with “no option” CLTI. DVA involves creating an arteriovenous fistula proximal to diseased infrapopliteal arteries with the use of a covered stent. Once matured, the venous system then delivers oxygenated arterial blood to the foot through the pedal venous supply.

Clinical Findings/Procedure Details:

In this educational exhibit, we will (1) describe cases of “no-option” CLTI, (2) define appropriate patient selection for the procedure, (3) illustrate the technique for transcatheter DVA including its risks and potential complications, (4) discuss appropriate post-procedure care, and (5) demonstrate procedural success and long-term clinical outcomes of DVA.

Conclusion and/or Teaching Points:

Transcatheter DVA is a safe, feasible procedure for patients with CLTI that have no conventional surgical or endovascular revascularization treatment options.