Transcatheter Arterialization Provides Safe and Effective Treatment for No-option CLI

Clinical question: Is transcatheter arterialization of lower extremity deep veins safe and effective in preventing above-ankle amputation in patients with advanced chronic limb ischemia (CLI) who are otherwise not candidates for arterial revascularization? Ms.Sanford Background: About 20% of patients with CLI are not candidates for arterial revascularization (“no-option”) due to insufficient distal arterial target vessels, and have low amputation-free survival (42%). Transcatheter arterialization of deep veins involves percutaneous creation of an arteriovenous fistula using a stent to connect the tibial artery to an adjacent vein to provide oxygenated blood to the distal lower extremity through reverse flow in pedal veins and may be an option for these patients with CLI. Study design: Prospective, single-group, multicenter study Setting: 20 sites in the U.S. Synopsis: Investigators enrolled 105 participants with no-option CLI who had focal or extensive tissue loss or gangrene, 74% of whom had prior unsuccessful revascularization. They included patients on dialysis with stable AV fistula or peritoneal dialysis. All patients received dual antiplatelet therapy for at least three months. Following 104 (99%) successful procedures of creating an artery-to-vein connection, 66% of the patients had amputation-free survival at six months, which exceeded the performance goal (54%). At six months, 25% of participants had complete wound healing, and another 51% had wound healing in...
Source: The Hospitalist - Category: Hospital Management Authors: Tags: In the Literature Vascular Source Type: research