Advertisement

Simplified Endovascular Deep Venous Arterialization for Non-option CLI Patients by Percutaneous Direct Needle Puncture of Tibial Artery and Vein Under Ultrasound Guidance (AV Spear Technique)

  • Shigeo IchihashiEmail author
  • Yuichi Shimohara
  • Francesco Bolstad
  • Shinichi Iwakoshi
  • Kimihiko Kichikawa
Case Report
  • 10 Downloads

Abstract

The following case report describes the AV spear technique for percutaneous deep venous arterialization. After an ultrasound survey was performed to find the puncture point adjacent to the ankle joint where the posterior tibial vein (PTV) runs superficially to the posterior tibial artery (PTA), percutaneous penetration of the PTV and PTA was conducted. Then a microguidewire was inserted from the distal puncture site into the PTA and advanced into the arterial sheath, establishing a through-and-through wire. A microcatheter was then advanced antegradely over the through-and-through wire. After removing the wire, a hydrophilic guidewire was utilized in order to identify the venous lumen. Finally, a balloon angioplasty was conducted to create an AV fistula, which was reinforced by stent placement.

Keywords

Percutaneous deep venous arterialization Endovascular procedures Peripheral arterial disease 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Consent for Publication

Consent for publication was obtained for the person’s data included in the study.

References

  1. 1.
    Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg. 2007;45(Suppl S):S5–67.CrossRefGoogle Scholar
  2. 2.
    Agarwal S, Sud K, Shishehbor MH. Nationwide trends of hospital admission and outcomes among critical limb ischemia patients: from 2003–2011. J Am Coll Cardiol. 2016;67:1901–13.CrossRefGoogle Scholar
  3. 3.
    Adam DJ, Beard JD, Cleveland T, Bell J, Bradbury AW, Forbes JF, Fowkes FG, Gillepsie I, Ruckley CV, Raab G, Storkey H. Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet. 2005;366:1925–34.CrossRefGoogle Scholar
  4. 4.
    Kum S, Tan YK, Schreve MA, Ferraresi R, Varcoe RL, Schmidt A, Scheinert D, Mustapha JA, Lim DM, Ho D, Tang TY, Alexandrescu VA, Mutirangura P. Midterm outcomes from a pilot study of percutaneous deep vein arterialization for the treatment of no-option critical limb ischemia. J Endovasc Ther. 2017;24:619–26.CrossRefGoogle Scholar
  5. 5.
    Del Giudice C, Van Den Heuvel D, Wille J, Mirault T, Messas E, Ferraresi R, Kum S, Sapoval M. Percutaneous deep venous arterialization for severe critical limb ischemia in patients with no option of revascularization: early experience from two european centers. Cardiovasc Intervent Radiol. 2018;41:1474–80.CrossRefGoogle Scholar
  6. 6.
    Gandini R, Merolla S, Scaggiante J, Meloni M, Giurato L, Uccioli L, Konda D. Endovascular distal plantar vein arterialization in dialysis patients with no-option critical limb ischemia and posterior tibial artery occlusion: a technique for limb salvage in a challenging patient subset. J Endovasc Ther. 2018;25:127–32.CrossRefGoogle Scholar
  7. 7.
    Mustapha JA, Saab FA, Clair D, Schneider P. Interim results of the PROMISE I trial to investigate the limflow system of percutaneous deep vein arterialization for the treatment of critical limb ischemia. J Invasive Cardiol. 2019;31:57–63.PubMedGoogle Scholar
  8. 8.
    Ysa A, Lobato M, Mikelarena E, Arruabarrena A, Gomez R, Apodaka A, Metcalfe M, Fonseca JL. Homemade device to facilitate percutaneous venous arterialization in patients with no-option critical limb ischemia. J Endovasc Ther. 2019;26:213–8.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2019

Authors and Affiliations

  1. 1.Department of RadiologyNara Medical UniversityKashiharaJapan
  2. 2.Department of Clinical EnglishNara Medical UniversityNaraJapan

Personalised recommendations