Early Experience With Venous Arterialization for Limb Salvage in No-Option Patients With Chronic Limb-Threatening Ischemia

Abstract

Chronic limb-threatening ischemia (CLTI) is associated with adverse limb outcomes and increased mortality. In a small subset of the CLTI population, no feasible conventional methods will be available for revascularization. However, venous arterialization (VA) provides an alternative for limb salvage. Our objective was to review the outcomes of VA at our institution. We performed a single-institution review of 41 patients followed up prospectively who had undergone either superficial or deep VA. The data collected included patient demographics, comorbidities, VA technique (endovascular vs hybrid), and WIfI (wound, ischemia, foot infection) limb staging. The following outcomes were collected at 1-month, 6-months, and 1-year intervals: patency, wound healing, major adverse limb events, major amputation, and death. Descriptive statistics were used for analysis. The study group included 41 patients who had undergone successful open hybrid superficial or deep endovascular VA. Of the 41 patients, 21 (51.2%) had undergone a purely endovascular procedure and 20 (48.8%) had undergone hybrid VA. The WIfI clinical stage was as follows: stage 4, 33 (80.5%); stage 3, 6 (14.6%); and stage 2, 2 (4.9%). At the last follow-up, 21 patients (51.2%) had completed 6 months of follow-up and 13 (31.7%) had completed 12 months of follow-up. Of the 41 patients, 6 (14.6%) were lost to follow-up after 1 month. VA patency for those available for follow-up was 80.5% (n = 33) at 1 month, 71.4% (n = 15) at 6 months, and 69.2% (n = 9) at 12 months (Table). The wound healing rates were 39% (n = 16) at 1 month, 71.4% (n = 15) at 6 months, and 76.9% (n = 10) at 12 months. The major adverse limb event rates were 19.5% (n = 8) at 1 month, 33.3% (n = 7) at 6 months, and 38.4% (n = 5) at 12 months. Major amputation occurred in 5 limbs (12.2%) at 1 month, 2 limbs (9.5%) at 6 months, and 0 limbs (0%) at 12 months. Of the patients, none (0%) had died at 1 month. At 6 months, 4 of the 21 patients (19%) had died. However, two of the deaths (9.5%) were attributed to COVID-19 (coronavirus disease 2019). No further patients had died within 12 months. The limb salvage survival probability at 12 months was 87.5% (Fig). These findings suggest that for a select subset of CLTI patients presenting with high WIfI clinical limb stage CLTI and no viable options for conventional open or endovascular arterial revascularization, superficial and deep VA are safe and effective options to achieve limb salvage.TableVenous arterialization outcomes at 1, 6, and 12 monthsVariable1 Month6 Months12 MonthsVA patency80.5 (33)71.4 (15)69.2 (9)Wound healing39 (16)71.4 (15)76.9 (10)MALE19.5 (8)33.3 (7)38.4 (5)Limb salvage87.8 (36)78.3 (32)78.3 (32)Mortality0 (0)19 (4)19 (4)MALE, Major adverse limb events.Data presented as percentage (number). Open table in a new tab