Novel Endovascular Surgery May Help In Avoiding Amputation In Limb Ischemia Cases

A novel approach – transcatheter arterialization of the deep veins, has been shown to be useful as a revascularization option in multiple patients with chronic limb-threatening ischemia. This surgery can aid in avoiding limb amputation in these patients by providing means for circulation restoration.

Mainstay management strategies for limb ischemia include – addressing risk factors for cardiovascular disease through pharmaceutical drugs and revascularizing the affected limb to promote wound healing. For revascularization, either surgical bypass or minimally invasive endovascular techniques. However, in about 15-20% of the cases, conventional revascularization may not be feasible as an arterial connection point may not be available; that is, a downstream target of an unobstructed vessel––landing point. 

A new revascularization technique was recently devised, which advocates connecting the associated artery to the downstream deep-venous segments. This will lead to a reversal of blood flow in the veins and perfusion of the venous blood into the ischemic limb instead.

The PROMISE II study that recruited 105 patients with advanced chronic limb-threatening ischemia depicted procedural success in 99% of patients who underwent the novel revascularization surgery. Further, amputation-free survival was also recorded for six months after the procedure in 66.1% of the participants.