167 - Non-Posterior Tibial Artery Deep Vein Arterialization: The Lesser Known Path

Monday, April 13, 2026

4:12 PM - 4:21 PM ET

Author/Co-author(s)

SH

Shaan Haider, BS

MS2
Medical College of Georgia at Augusta University, United States
NZ

Naveed Zaman, BS

Medical Student
Keck School of Medicine of USC, United States
ZN

Zola N'Dandu, MD

Interventional Cardiologist
Ochsner Medical Center - Kenner, United States
MW

Mike Watts, MD, FSIR

Interventional Radiologist
Atlantic Medical Imaging, United States
MS

Michael Siah, MD

Assistant Professor of Vascular Surgery
UT Southwestern Medical Center, United States
Sabeen Dhand, MD

Interventional Radiologist
Harbor UCLA Medical Center, United States
John H. Rundback, MD, FSIR

Managing Partner
Advanced Interventional & Vascular Services, LLP, United States
Kumar Madassery, MD

Associate Professor, Vascular and Interventional Radiology
Rush University Medical Center, Rush Oak Park, United States

Presenting Author(s)

Akhilesh Pillai (he/him/his)

Medical Student
McGovern Medical School UTHealth Houston, United States

Purpose: Percutaneous deep vein arterialization (pDVA) is an innovative alternative for no-option/poor-option critical limb-threatening ischemia (CLTI) patients, offering a strategy to prevent major amputations. The majority of pDVAs are created using the posterior tibial artery (PTA) and vein due to easier anatomy. In the absence of a PTA or other obstructing factors, alternative targets may exist for pDVA, but this approach is only minimally described in the literature.

Materials and Methods: Retrospective review was performed across 5 institutions that perform a high volume of pDVA cases, yielding 34 cases of pDVA where the PTA was not used. Data points included donor artery, reason for PTA pDVA ineligibility, crossover and scaffold type, wound healing/location, and limb salvage outcomes.

Results: Of the 34 cases, the donor arteries were: anterior tibial artery (16/34), peroneal artery (10/34), and the tibioperoneal trunk (8/34). Technical success was achieved in 97% (33/34) of cases, with 1 failure due to lack of attaining venous pedal outflow. Crossover devices were: Outback (15/34), LimFlow System (8/34), Beback (6/34), Pioneer (3/34), and Gunsight (2/34) approaches. Outflow scaffolds were used in 30/34 cases: Viabahn (22/30) and LimFlow (8/30) graft; and at the fistula in 33/34 cases using Viabahn (16/34), Xience (9/34), and LimFlow (8/34) stents. The most frequent non-PTA pDVA creation causes were: PTA providing sole arterial pedal perfusion (9/34), inability to cross into the PTA (7/34), and the anterior tibial artery providing sole arterial pedal perfusion (4/34). Wound location prior to pDVA was in the forefoot (31/34) and heel (3/34).

Complete wound healing was observed in 18/34 patients, with on-going/active wound healing occurring in 3/34 additional patients. Patency of the pDVA fistula ranged from 0 months to 57 months, with a median time of 3 months and reinterventions performed in 3/34 patients. Major amputations occurred in 7/34 patients, with 5 below the knee and 2 above the knee amputations. Minor amputations were performed in 15 patients, comprising 12 TMA and 3 toe amputations. Limb salvage was observed in 79.41% (27/34) of patients with a non-PTA pDVA.

Conclusion: pDVA creation has developed as an approach to offer limb preservation for no-option/poor-option CLTI patients, with acceptable and sustained amputation-free survival. Though the posterior tibial artery is the most common target for pDVA creation, alternative arteries can provide suitable revascularization targets with similar rates of limb salvage and should be considered.