TECHNOLOGY

MEDICAL & SCIENTIFIC

A recent meta-analysis from the European Journal of Vascular and Endovascular Surgery reviewed the existing body of literature on venous arterialization. The article, entitled “Meta-Analysis of the clinical effectiveness of venous arterialization for salvage of critically ischaemic limbs”1, reviewed a total of 56 studies and analyzed data from seven patient series, comprising 228 patients.

Overall 1-year foot preservation was 71% (95% confidence interval: 64-77%), and 1-year secondary patency was 46% (95% CI 39-53%).

The large majority of patients who avoided major amputation experienced successful wound healing, disappearance of rest pain, and absence of serious complications.

The authors found that “on the basis of limited evidence, venous arterialization may be considered as a viable alternative before major amputation is undertaken in patients with ‘inoperable’ chronic critical leg ischemia”.

Reference Articles on Deep Vein Arterialization:

  1. Percutaneous Deep Venous Arterialization. http://evtoday.com/2015/05/percutaneous-deep-venous-arterialization A brief technical overview of a new therapy for treating end-stage “no-option” critical limb ischemia. By Steven Kum, MD; Yih Kai Tan, MD; Tjun Tang, MD; Andrej Schmidt, MD; Dierk Scheinert, MD; and Roberto Ferraresi, MD. Endovascular Today, May 2015
  2. Lu XW, Idu MM, Ubbink DT, Legemate DA. (2006). Meta-analysis of the clinical effectiveness of venous arterialization for salvage of critically ischaemic limbs. Eur J Vasc Endovasc Surg. 2006 May;31(5):493-9.
  3. Mutirangura P, Ruangsetakit C, Wongwanit C, Sermsathanasawadi N, Chinsakchai K. (2011) Pedal bypass with deep venous arterialization: the therapeutic option in critical limb ischemia and unreconstructable distal arteries. Vascular. 2011 Dec;19(6):313-9
  4. Alexandrescu V, Ngongang C, Vincent G, Ledent G, Hubermont G. (2010). Deep calf veins arterialization for inferior limb preservation in diabetic patients with extended ischaemic wounds, unfit for direct arterial reconstruction: preliminary results according to an angiosome model of perfusion. Cardiovasc Revasc Med. 2011 Jan-Feb;12(1):10-9.
  5. M.A. Schreve, C.G. Vos, A.C. Vahl, J.P.P.M. de Vries, S. Kum, G.J. de Borst, Ç. Ünlü (2006) Venous Arterialisation for Salvage of Critically Ischaemic Limbs: A Systematic Review and Meta-Analysis j.ejvs.2016.11.007
  6. Djoric P, Zeleskov-Djoric J, Stanisavljevic DM, Markovic ZD, Zivkovic V, Vuletic M, Djuric D, Jakovljevic V. (2012) Distal venous arterialization and reperfusion injury: focus on oxidative status. Eur Surg Res. 2012;48(4):200-7
  7. Matarrese MR, Hammert WC. (2011). Revascularization of the ischemic hand with arterialization of the venous system. J Hand Surg Am. 2011 Dec;36(12):2047-51
  8. Djoric P (2011). Early individual experience with distal venous arterialization as a lower limb salvage procedure. Am Surg. 2011 Jun;77(6):726-30.
  9. Nguyen PS, Legré R, Gay AM. (2011). Treatment of hand ischemia with arterialization of the venous system of the hand: report of three cases.Ann Chir Plast Esthet. 2011 Jun;56(3):200-6
  10. Pokrovsky AV, Dan VN, Chupin AV, Kalinin AA. (2007)Arterialization of the hand venous system in patients with critical ischemia and thrombangiitis obliterans. Angiol Sosud Khir. 2007;13(2):105-11. English, Russian.
  11. Asher E, Veith FJ: Arterialization of the distal venous system alone or combined with bypasses to limited outflow tracts. Perspectives in Vascular Surgery. 6:67-83, 1993.
  12. Gavrilenko AV, Skrylev SI (2007) Long-term results of venous blood flow arterialization of the leg and foot in patients with critical lower limb ischemia. Angiol Sosud Khir. 2007;13(2):95-103. English, Russian.
  13. Miasnik BN, Abidov MM, Karimov ZZ. (2002) Scintigraphic evaluation of the efficacy of nonstandard methods of treating critical ischemia of the lower limbs. Khirurgiia (Mosk). 2002;(6):48-51. Russian.
  14. Engelke C, Morgan RA, Quarmby JW, Taylor RS, Belli AM. (2001). Distal venous arterialization for lower limb salvage: angiographic appearances and interventional procedures. Radiographics. 2001 Sep-Oct;21(5):1239-48;
  15. Jacob S, Nassef A, Belli AM, Dormandy JA, Taylor RS. (1999) Vascular surgical society of great britain and ireland: distal venous arterialization for non-reconstructable arterial disease Br J Surg. 1999 May;86(5):694.
  16. Kopelman D, Hirshhorn G, Hashmonai M. (1998). Prevention of limb loss in critical ischaemia by arterialization of the superficial venous system: an experimental study in dogs. Cardiovasc Surg. 1998 Aug;6(4):384-8.
  17. Protsenko NV, Petin GI, Krasavin VA, Strelets BM. (1990) Arterialization of the venous bed in acute critical ischemia of the extremity. Sov Med. 1990;(12):77-9. Russian.
  18. Sheil GR. (1977). Treatment of critical ischaemia of the lower limb by venous arterialization : an interim report. Br J Surg. 1977 Mar;64(3):197-9.
  19. Sasajima T, Azuma N, Uchida H, Asada H, Inaba M, Akasaka N. (2009). Combined distal venous arterialization and free flap for patients with extensive tissue loss. Ann Vasc Surg. 2010 Apr;24(3):373-81.
  20. Keshelava G, Gigilashvili K, Chkholaria A, Pagava G, Janashia G, Beselia K. (2009) Foot venous system arterialization for salvage of nonreconstructable acute ischemic limb: a case report. J Vasc Nurs. 2009 Mar;27(1):13-6
  21. Gasparis AP, Noor S, Da Silva MS, Tassiopoulos AK, Semel L. (2002). Distal venous arterialization for limb salvage--a case report. Vasc Endovascular Surg. 2002 Nov-Dec;36(6):469-72.
  22. Rowe VL, Hood DB, Lipham J, Terramani T, Torres G, Katz S, Kohl R, Weaver FA. (2002) Initial experience with dorsal venous arch arterialization for limb salvage. Ann Vasc Surg. 2002 Mar;16(2):187-92
  23. Lengua F, La Madrid A, Acosta C, Barriga H, Maliqui C, Arauco R, Lengua A (2001) Arterialization of the distal veins of the foot for limb salvage in arteritis. Techniques and results]. Ann Chir. 2001 Sep;126(7):629-36
  24. Pederson WC. (1999). Revascularization of the chronically ischemic hand. Hand Clin. 1999 Nov;15(4):629-42.
  25. Houlind K, Christensen J, Hallenberg C, Jepsen JM (2013) Early results from an  angiosome-directed open surgical technique for venous arterialization in patients with  critical limb ischemia. Diabet Foot Ankle. Dec 2013, 17;4
  26. Schreve MA, Minnee RC, Bosma J, Leijdekkers VJ, Idu MM, Vahl AC (2014) Comparative study of venous arterialization and pedal bypass in a patient cohort with  critical limb ischemia. Ann Vasc Surg. 2014. Jul;28(5): 1123-7
  27. Busato, CR et al. The great saphenous vein in situ for the arterialization of the venous  arch of the foot. J. vasc. bras 2010, vol.9, n.3, pp. 119-123
  28. Taylor RS, Belli AM, Jacob S. (1999) Distal venous arterialisation for salvage of critically ischaemic inoperable limbs. Lancet. 1999 Dec 4;354 (9194):1962-5.
  29. Lengua, Francisco, Madrid, Andrés La, Acosta, Carlos, & Vargas, Jorge. (2010). Temporal venous arterialization of the diabetic foot. Jornal Vascular Brasileiro, 9(1), 14-20. Epub 23 de abril de 2010.
  30. Vlad Alexandrescu. Is Limb Loss Always Inevitable for Critical Neuro-Ischemic Foot Wounds in Diabetic Patients with End Stage Renal Disease and Unfit for Vascular Reconstructions? Chapter 13 in: Diseases of Renal Parenchyma. edited Manisha Sahay, ISBN 978-953-51-0245-8, Published: March 16, 2012 under CC BY 3.0 license. DOI: 10.5772/26361
  31. Pederson WC. Revascularization options for terminal distal ischemia. Hand Clin. 2015 Feb; 31(1):75-83. doi: 10.1016/j.hcl.2014.09.007.