Twelve-Month Clinical Outcomes of Percutaneous Deep Venous Arterialization with Alternative Techniques and Ordinary Endovascular Therapy Devices for Patients with Chronic Limb-Threatening Ischemia: Results of the DEPARTURE Japan Study

• Published in: Cardiovascular and interventional radiology 2022-05, Vol.45 (5), p.622-632
• Main Authors: Nakama, Tatsuya, Ichihashi, Shigeo, Ogata, Kenji, Kojima, Shunsuke, Muraishi, Makio, Obunai, Kotaro, Watanabe, Hiroyuki
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Amputation; Arterial Interventions; Cardiology; Cardiovascular system; Chronic Limb-Threatening Ischemia; Clinical Investigation; Clinical outcomes; Diabetes mellitus; Endovascular Procedures; Female; Follow-Up Studies; Hemodialysis; Humans; Imaging; Ischemia; Ischemia - diagnostic imaging; Ischemia - surgery; Japan; Limb Salvage; Male; Medicine; Medicine & Public Health; Nuclear Medicine; Patients; Peripheral Arterial Disease - diagnostic imaging; Peripheral Arterial Disease - therapy; Radiology; Retrospective Studies; Risk Factors; Survival; Treatment Outcome; Ultrasound; Wound healing
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-022-03095-1

Purpose A dedicated treatment strategy is not yet established for patients with no-option chronic limb-threatening ischemia. This study aimed to evaluate the clinical outcomes of percutaneous deep venous arterialization in Japanese patients with no-option chronic limb-threatening ischemia. Materials and Methods Data of 18 consecutive patients with chronic limb-threatening ischemia (18 limbs; mean age: 75.5 ± 8.5 years; 14 men) who underwent percutaneous deep venous arterialization between January 2016 and November 2020 were retrospectively reviewed. The limb salvage, amputation-free survival, and wound healing rates were evaluated using the Kaplan–Meier method. Results Among 18 patients, 14 (77.8%) had diabetes, 6 (33.3%) had a non-ambulatory status, 16 (88.9%) received hemodialysis, and 15 (83.3%) had wound, ischemia, and foot infection of clinical stage 4. Rutherford 5 was observed in 33.7% of the patients and Rutherford 6 in 66.7%. The technical success rate of percutaneous deep venous arterialization was 88.9%. Four patients required major amputation within 30 days; percutaneous deep venous arterialization failed in two of these patients. At 6 and 12 months, the limb salvage rates, amputation-free survival rates, and complete wound healing rates were 72.2 and 72.2%, 55.6 and 49.4%, and 23.0 and 53.2%, respectively. The median time to complete wound healing was 234 (interquartile range, 127–306) days. Conclusion This study presented the clinical outcomes of patients with chronic limb-threatening ischemia who underwent percutaneous deep venous arterialization in Japan. Acceptable, safe, and efficacious results were reported. Before major amputation, percutaneous deep venous arterialization can be considered for patients with no-option chronic limb-threatening ischemia. Level of Evidence Level 3. Non-randomized, follow-up study.