A last resort that works: Distal deep vein arterialization in no-option diabetic critical limb-threatening ischemia: A prospective interventional study.

Background

Chronic limb-threatening ischemia (CLTI) is the most advanced stage of peripheral arterial disease characterized by ischemic rest pain, non-healing ulcers, and gangrene. In patients with "no-option" CLTI, distal deep vein arterialization (DDVA) offers a potential limb salvage strategy. We prospectively studied the outcomes of open DDVA in patients with diabetes with CLTI.

Methods

This prospective interventional case series included 10 patients with diabetes with CLTI (rest pain, ulcers, or gangrene) confirmed using duplex ultrasonography and CT angiography underwent open DDVA. Vascular anastomosis was performed between the posterior tibial artery (PTA, n = 9) or anterior tibial artery (ATA, n = 1) and one of its venae comitantes in the tarsal tunnel. Demographics, operative details, and postoperative outcomes were analyzed. The outcomes of interest included wound healing, pain relief, limb salvage and mortality.

Results

The cohort included 8 men and 2 women, with a mean age 59.6 years. All patients underwent DDVA between the posterior/anterior tibial artery and corresponding vena comitans. By 1 month, 6 patients achieved complete wound healing, whereas 4 had small residual ulcers that fully healed by 2 months, and mean VAS pain scores improved from 7.7 to 1.8. at 2 months, CT angiography confirmed patent arterio-venous anastomoses in all patients. At an average follow-up of 12.5 ± 5.9 months, all patient achieved ambulatory, ulcer free, and major amputation-free survival.

Conclusion

Open DDVA is a feasible and effective revascularization option in no-option diabetic CLTI, which offers encouraging early results in limb salvage, wound healing, and pain relief. Larger studies with longer follow-up and objective perfusion assessment are warranted.