ObjectiveTo compare the efficacy of percutaneous deep venous arterialization in no-option chronic limb-threatening ischemia patients in the hospital versus office-based laboratory setting. MethodsA retrospective chart review was performed of all patients who underwent percutaneous deep venous arterialization using off-the-shelf devices from January 2018 to March 2023 in a hospital and an office-based laboratory. 73 eligible patients were identified, 41 hospital (59% male, median age (interquartile range) of 72 (18) years) and 32 office-based laboratory (59% males, 67 (16) years) patients. All eligible patients were deemed to have “no-option” critical limb ischemia, had at least 1 patent proximal tibial artery available for creation of the arteriovenous anastomosis, and were classified as having Rutherford category 4 or higher peripheral arterial disease. Patients were ineligible if classified as Rutherford category 3 or less, had active infection, did not have at least 1 appropriate venous target, and/or had rapidly progressing wounds requiring immediate major amputation. The primary outcome was major amputation-free survival. Secondary outcomes included technical success, limb salvage, survival, primary patency, re-intervention rate, adverse events, partial and complete wound healing. Outcomes were evaluated using Kaplan-Meier method, log-rank and two-stage procedure tests. ResultsTechnical success was achieved in 70 (96%) patients with 1 (2.4%) hospital and 2 (6.3%) office-based laboratory patients lost to follow-up. Major amputation-free survival estimates at 6 months, 1-year and 2-year were 51.4%, 40.4%, 30.2% in the hospital group and 69.4%, 54.0%, and 49.5% in the office-based laboratory group, respectively. Partial wound healing estimates at 6 months, 1-year and 2-year were 27.5%, 71.7%, 81.2% in the hospital group and 62.7% at all time points in the office-based laboratory group. Complete wound healing estimates at 6 months, 1-year and 2-year were 6.7%, 33.3%, 33.3% in the hospital group and 5.3%, 37.7%, and 41.6% in the office-based laboratory group, respectively. There was no significant difference in major amputation-free survival (p=.13), limb salvage (p=.07), survival (p=.69), primary patency (p=.53), partial (p=.08) or complete wound healing (p=.79) between groups. Re-intervention was performed in 8 (20.5%) hospital and 14 (45.2%) office-based laboratory patients. ConclusionPercutaneous deep venous arterialization is a feasible and safe procedure for no-option critical limb ischemia in the hospital and office-based laboratory setting without significant differences in outcomes at up to 2 years.