Interventional procedure overview of percutaneous deep venous arterialisation for chronic limb-threatening ischaemia

What the procedure involves

This procedure uses an endovascular, minimally invasive approach. An arterio-venous fistula is created to allow venous arterialisation in the below-the-knee vasculature. The aim is to restore blood flow to the ischaemic foot.

Preoperative investigation is needed to confirm adequate pedal venous anatomy and identify a proper crossover point between the vessels.

This procedure is usually done using general anaesthesia, and with ultrasound guidance. Antegrade arterial access via in the common femoral artery and retrograde venous access via the tibial vein are established. The arterial and venous catheters are inserted and advanced to the target artery and vein (most frequently the posterior tibial artery and vein). Once both catheters are positioned at the crossover point, a needle is deployed to create an arteriovenous fistula. After balloon dilatation valvulotomy of the vein is performed, usually from the crossing point to the midfoot. Multiple stents are placed from the level of the calcaneus to the arteriovenous crossover point, and a crossing stent is then inserted to maintain the arteriovenous fistula. This establishes retrograde blood flow down the veins which become arterialised.

Arteriography is done at the end of the procedure to visualise blood flow into the deep venous arch.