Abstract 1143: Unraveling Histological Dynamics In Deep Venous Arterialization For Chronic Limb-threatening Ischemia

Abstract

Introduction: Deep venous arterialization (DVA) is emerging as a promising alternative for no-option CLTI) but its pathophysiology remains incompletely understood. Research question: What histologic changes occur in the limb after DVA to allow tissue oxygenation? Study aim: To uncover histological alterations induced by DVA and provide a framework for future experimental models to explore early radiologic and histologic markers of successful DVA. Methods: We report the case of a 53-year-old female who underwent a percutaneous DVA for CLTI using a covered stent (Fig.1). The intervention was successful with evidence of improved blood flow to the foot, but the patient presented worsening infection leading to a below-knee amputation 4 weeks later. A high-resolution 7T MRI was used to scan the amputated limb, and the blood vessels were harvested for histology analysis. Results: The MRI confirmed the patency of the DVA stent graft (Fig. 2A) and plantar loop while histology demonstrated evidence of valvular disruption and eccentric neointimal hyperplasia (NIH) in the vein that underwent intervention (Fig 2B). There was also evidence of NIH and increased smooth muscle cells in the media of the paired vein that did not undergo intervention, resulting in greater thickness compared to the media of the anterior tibial vein at the same level (Fig 2C). Conclusion: Our case reveals some of the changes induced by DVA and demonstrates a possible role of the untouched paired vein in facilitating arterialized flow to the foot. This offers a framework for experimental studies to further investigate these histological alterations and their role in prognosticating DVA outcomes.