Distinct Temporal Patterns of Limb Loss and Mortality After Transcatheter Arterialization of the Deep Veins for No-Option CLTI.
TL;DR
Findings support TADV as a limb-salvage option for patients with no-option CLTI who would otherwise face major amputation, although larger multicenter studies are needed to confirm long-term durability.
Abstract
Objective
No-option chronic limb-threatening ischemia (CLTI) represents the most advanced stage of peripheral arterial disease, characterized by exhausted revascularization options and substantial systemic comorbidity. Contemporary registry data have reported amputation-free survival (AFS) as low as approximately 37% at 1 year with standard care alone. Deep venous arterialization (DVA) has emerged as a limb-salvage strategy for these patients by arterializing the venous circulation to restore perfusion to the distal extremity. Although early trial data have been encouraging, the durability of Transcatheter Arterialization of the Deep Veins (TADV) in routine clinical practice beyond the trial setting remains incompletely defined. We evaluated 2-year technical and clinical outcomes following TADV in a single-center cohort.
Methods
We performed a retrospective, single-center cohort study of 29 consecutive patients with no-option CLTI who underwent TADV, with follow-up extending up to 2 years. Outcomes assessed included technical success, 30-day circuit patency, major amputation, limb salvage, all-cause mortality, and amputation-free survival (AFS). Kaplan-Meier methods were used to estimate time-to-event outcomes, and univariable Cox regression was used to identify baseline factors associated with AFS and mortality.
Results
Technical success was achieved in all 29 patients (100%). During the follow-up, limb salvage was maintained in 22 of 29 patients (75.9%) (Table 2). The Kaplan-Meier limb-salvage curve plateaued after approximately 7 months, with no major amputations observed among patients who remained amputation-free beyond this point (Figure 1). All-cause mortality was 41.4% (12 of 29 patients) and increased throughout follow-up (Table 2). Older age was significantly associated with mortality (median, 77 vs 71 years; P = .047), and congestive heart failure showed a nonsignificant trend toward increased mortality risk (83.3% vs 47.1%; P = .064) (Table 3).
Conclusions
In this cohort of patients with no-option CLTI, TADV achieved durable limb preservation in approximately three-quarters of patients through 2 years of follow-up, with amputation occurring almost exclusively within the first several months after the procedure. All-cause mortality remained substantial throughout follow-up, consistent with the comorbidity burden of this population. These findings support TADV as a limb-salvage option for patients with no-option CLTI who would otherwise face major amputation, although larger multicenter studies are needed to confirm long-term durability.