Perkutane tiefe Venenarterialisierung: Neue Hoffnung für Patienten mit kritischer Extremitätenischämie ohne Therapieoption

Chronic limb-threatening ischemia (CLTI) is a potentially life-threatening condition with high amputation rates. End-stage CLTI, also known as no option CLTI, is present in up to 20% of CLTI patients and is characterized by occluded plantar arteries without a revascularization target in the foot. Percutaneous deep vein arterialization is a novel minimally invasive development of the already established technique for the treatment of no option CLTI. After establishing an arteriovenous fistula between a distally occluded tibial artery and its accompanying vein, the venous valves are made incompetent using a valvulotomy and proprietary stent-grafts are then implanted in the artery and vein through the arteriovenous fistula, establishing arterial flow to the foot through the venous plantar arch. The first clinical trials showed promising results with an amputation-free survival of 60–70% after 12 months; however, frequent reinterventions and high procedural costs remain significant limitations of this technique.