Management of venous outflow branches in transcatheter arterialization of deep veins.

Abstract

Transcatheter arterialization of deep veins TADV) represents an emerging limb salvage option for patients with chronic limb-threatening ischemia (CLTI) who are unfit for conventional revascularization options. The coiling of venous outflow branches is a commonly performed adjunct procedure described in successful TADV. However, there are limited data on its benefits. This study aims to evaluate clinical outcomes and flow volumes after TADV without subsequent venous branch coiling. A retrospective chart review was done on a prospectively enrolled cohort of no-option CLTI patients who underwent TADV at a single tertiary institute between 2020 and 2024. Clinical outcomes were evaluated at 1 year. Flow volumes assessed at the 1- and 3-month follow-ups through standardized duplex ultrasound measurements were collected. Descriptive statistics and Kaplan-Meier analyses were used to assess flow volumes, survival and limb salvage rates. Of the 23 patients treated (mean age, 66.04 ± 12.8 years; 74% male), the survival rate was 86% (interquartile range [IQR], 72.8-100) and the limb salvage rate was 87% (interquartile range, 74.2-100). Median initial flow volumes at 1 month were 462.5 mL/min at inflow, 299.0 mL/min at midstent, 390.0 mL/min at outflow, and 196.0 mL/min at the lateral plantar vein. By 3 months, these volumes showed expected moderation to 223.0 mL/min, 179.0 mL/min, 261.0 mL/min, and 103.0 mL/min, respectively. TADV, performed without embolization of venous outflow collaterals and with close surveillance, maintained sufficient distal perfusion at 3 months, achieving a limb salvage rate of 87%. This offers a promising option for CLTI patients, minimizing procedural complexity while preserving positive outcomes.