A Review of Revascularization Procedures in the No-Option Critical Limb Ischemia Patient

S. Mathew, D. Kesani

Purpose: Some patients with critical limb ischemia (CLI) may not have endovascular or surgical options for arterial revascularization. These patients are sometimes called no-option CLI patients. In this patients, deep venous arterialization via formation of an arteriovenous fistula allows for perfusion of the ischemic lower extremity. This review will help readers understand the indications for treatment and discuss various endovascular and surgical approaches with attention toward new data.

Materials and Methods: A review of literature was performed using the PubMed database for terms “venous arterialization” or “vein arterialization” from 2020 onward, when there was a major review that compared varying approaches. Clinical trials and prospective and retrospective reviews were included. Case reports and articles not pertaining to peripheral arterial disease were excluded. The type of approach, whether endovascular or surgical, with details on different techniques was noted and will be elaborated. Outcomes of the study were noted with attention paid to wound healing rates and amputation-free survival.

Results: Percutaneous venous arterialization was performed using the LimFlow system, or commercially available systems with reentry devices, arteriovenous spear technique, and so on. Surgical approaches used grafts from veins or synthetic materials. Most studies used the endovascular approach. Cross-comparison among studies was limited by heterogeneity in follow-up and reporting of results. Amputation-free survival at 1 year ranged from 70% to 79.8% of patients, and healing of 46.3% to 75% of wounds took place over 1 year.

Conclusions: Surgical and percutaneous options are evolving in treatment of patients with no-option CLI. This review summarizes endovascular and surgical techniques and reviews newer data for treatment of patients with CLI.