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Magnetic Resonance Imaging and Histological Insights Into Deep Venous Arterialisation.
EJVES Vasc Forum
April 2024
Division of Vascular Surgery, Houston Methodist DeBakey Heart and Vascular Centre, Houston, TX, USA.
Introduction: Percutaneous deep venous arterialisation (DVA) is emerging as a promising alternative for limb salvage in chronic limb threatening ischaemia (CLTI) patients without any reasonable anatomical option for conventional revascularisation techniques. However, its mechanism of action remains incompletely understood. This report aimed to find some of the histological alterations occurring in the limb following DVA.
View Article and Find Full Text PDFTechnical Aspects of Percutaneous Deep Venous Arterialization Using Off-the-Shelf Devices.
J Endovasc Ther
June 2024
Department of Radiology, Tan Tock Seng Hospital, Singapore.
Purpose: Chronic limb-threatening ischemia (CLTI) represents the clinical end stage of lower extremity peripheral arterial disease (PAD). Although conventional open and endovascular revascularization options are available, some CLTI patients do not respond to these treatments, generally due to small vessel occlusive disease, with only limited or no clinical improvement achieved. This article aims to provide insights related to pertinent venous anatomy of the leg and below the ankle and a technical review of percutaneous deep venous arterialization (pDVA) creation using commonly-available devices.
View Article and Find Full Text PDFHybrid Deep Venous ARterialisation (DVAR) for No-Option Chronic Limb Threatening Ischemia.
Ann Vasc Surg
February 2022
Department of Vascular and Endovascular Surgery, Galway Clinic, Royal College of Surgeons in Ireland Affiliated Hospitals, Doughiska, GY, Ireland.
Background: Hybrid Deep Venous ARterialisation (DVAR) is offered as a last-ditch attempt for limb salvage in patients with chronic limb threatening ischemia (CLTI). It provides non-selective arterialisation independent of the angiosome, which harnesses the complex venous capillary network bed developed in the leg and foot.
Methods: We present two elderly men who underwent DVAR to salvage limb with CLTI.
Background: Chronic limb-threatening ischaemia (CLTI) in cases where there are no further standard treatment options for limb salvage represents the most advanced stage of peripheral arterial disease. For these "no-option" CLTI patients, an experimental treatment of foot vein arterialisation (FVA) was first described in 1912, however, it was never widely adopted as outcomes varied significantly most likely due to the complexity of the surgical intervention and lack of standardisation. In recent years there have been significant developments in performing FVA fully percutaneously and standardising the procedure with the introduction of specific indications for patient selection, a dedicated set of devices and structured follow up.
View Article and Find Full Text PDFTreatment of lower limb ischaemia in patients with diabetes.
Diabetes Metab Res Rev
March 2020
Vascular Surgery, Department of General Surgery, Sengkang General Hospital, Singapore, Singapore.
Diabetic chronic limb-threatening ischaemia is a challenging clinical problem with patients at high risk of diabetic foot ulceration (DFU) and limb loss. Patients often remain asymptomatic even in the presence of severe pedal ischaemia until first presenting with tissue loss such as DFU or frank gangrene. Limb salvage units should have the facilities and expertise to provide multidisciplinary team-based holistic care through best medical therapy, rapid diagnosis, prompt revascularisation with endovascular or open surgical techniques and expert wound management.
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