Pedal Venous Maturation on Duplex Ultrasound Predicts Outcomes after Venous Arterialisation in No Option Chronic Limb Threatening Ischaemia.

Abstract

To evaluate clinical outcomes and duplex ultrasound changes following venous arterialisation (VA) in patients with no option chronic limb threatening ischaemia (CLTI). A retrospective analysis was conducted on 23 patients with no option CLTI who underwent VA procedures with standardised pedal duplex ultrasound assessments at baseline, one week, three months, and six months. Pedal venous maturation (PVM) was defined as the presence of dilated terminal pedal veins with a colour Doppler signal and arterialised waveforms. PVM was correlated with VA patency, wound healing, and amputation free survival. At six months, amputation free survival was 85%; three patients underwent below knee amputation and one was lost to follow up. PVM developed in the lateral plantar vein of 86% (19 of 22) of patients at a mean of 112.5 ± 60.6 days (range 5 - 225 days). Once present, PVM persisted in 100% (19 of 19) of cases, including ten patients with VA occlusion. Wound healing occurred in 86% (19 of 22) of patients, including 100% (19 of 19) of those with PVM (p < .001). Healing was minor in 14% and major in 73%. All three patients who ultimately required amputation (at a mean of 152.7 ± 7 days) failed to achieve PVM. In contrast, 100% of patients with PVM remained amputation free at six months (p < .001). PVM strongly correlated with wound healing and limb preservation following VA in patients with no option CLTI. PVM may serve as a physiological marker for successful revascularisation and guide post-procedure surveillance strategies.