Percutaneous deep venous arterialization with balloon angioplasty salvaged a life‐threatening critical limb in a hemodialysis patient after repeated pedal angioplasty failed: A case report
Abstract Chronic limb‐threatening ischemia (CLTI) with severe below‐the‐ankle (BTA) lesions is often difficult to revascularize with endovascular treatment (EVT) and surgical treatment. We present a case of successful limb salvage using percutaneous deep venous arterialization (pDVA) in a patient wi...
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| Format: | Article |
| Language: | English |
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Wiley
2023-06-01
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| Series: | Clinical Case Reports |
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| Online Access: | https://doi.org/10.1002/ccr3.7589 |
| _version_ | 1797791743570083840 |
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| author | Tomonari Takagi Akira Miyamoto Norihiko Ohura Yasutaka Yamauchi |
| author_facet | Tomonari Takagi Akira Miyamoto Norihiko Ohura Yasutaka Yamauchi |
| author_sort | Tomonari Takagi |
| collection | DOAJ |
| description | Abstract Chronic limb‐threatening ischemia (CLTI) with severe below‐the‐ankle (BTA) lesions is often difficult to revascularize with endovascular treatment (EVT) and surgical treatment. We present a case of successful limb salvage using percutaneous deep venous arterialization (pDVA) in a patient with CLTI whose BTA lesion reconstruction failed. A 57‐year‐old man with diabetes mellitus and end‐stage renal failure on maintenance hemodialysis was referred to our hospital because of gangrene in the second and third toes of his left foot. EVT was repeated for the anterior tibial artery, posterior tibial artery (PTA), dorsal foot artery, and plantar artery lesions; however, revascularization below the ankle was unsuccessful. As the infection had spread to the sole of the foot, below‐the‐knee amputation was indicated, but the patient refused. Therefore, we performed pDVA on the left PTA simultaneously with a Lisfranc amputation. An arteriovenous fistula was created at the ankle joint using a Venous Arterialization Simplified Technique and a guidewire was inserted into the plantar vein. Balloon dilatation from PTA to the plantar vein was performed to complete the pDVA. Although repeated EVT was required to maintain blood flow in the pDVA, skin grafting was performed 3 months after the pDVA, the wound completely healed, and he was discharged 6 months after the DVA. The pDVA can be an option for limb salvage in patients with no‐option CLTI who are confronted by imminent amputation. |
| first_indexed | 2024-03-13T02:23:04Z |
| format | Article |
| id | doaj.art-70b27fb83cec49e39dac4c841b182f1d |
| institution | Directory Open Access Journal |
| issn | 2050-0904 |
| language | English |
| last_indexed | 2024-03-13T02:23:04Z |
| publishDate | 2023-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | Clinical Case Reports |
| spelling | doaj.art-70b27fb83cec49e39dac4c841b182f1d2023-06-30T07:34:08ZengWileyClinical Case Reports2050-09042023-06-01116n/an/a10.1002/ccr3.7589Percutaneous deep venous arterialization with balloon angioplasty salvaged a life‐threatening critical limb in a hemodialysis patient after repeated pedal angioplasty failed: A case reportTomonari Takagi0Akira Miyamoto1Norihiko Ohura2Yasutaka Yamauchi3Cardiovascular Center Takatsu General Hospital Kanagawa JapanCardiovascular Center Takatsu General Hospital Kanagawa JapanDepartment of Plastic and Reconstructive Surgery Kyorin University Hospital Mitaka JapanCardiovascular Center Takatsu General Hospital Kanagawa JapanAbstract Chronic limb‐threatening ischemia (CLTI) with severe below‐the‐ankle (BTA) lesions is often difficult to revascularize with endovascular treatment (EVT) and surgical treatment. We present a case of successful limb salvage using percutaneous deep venous arterialization (pDVA) in a patient with CLTI whose BTA lesion reconstruction failed. A 57‐year‐old man with diabetes mellitus and end‐stage renal failure on maintenance hemodialysis was referred to our hospital because of gangrene in the second and third toes of his left foot. EVT was repeated for the anterior tibial artery, posterior tibial artery (PTA), dorsal foot artery, and plantar artery lesions; however, revascularization below the ankle was unsuccessful. As the infection had spread to the sole of the foot, below‐the‐knee amputation was indicated, but the patient refused. Therefore, we performed pDVA on the left PTA simultaneously with a Lisfranc amputation. An arteriovenous fistula was created at the ankle joint using a Venous Arterialization Simplified Technique and a guidewire was inserted into the plantar vein. Balloon dilatation from PTA to the plantar vein was performed to complete the pDVA. Although repeated EVT was required to maintain blood flow in the pDVA, skin grafting was performed 3 months after the pDVA, the wound completely healed, and he was discharged 6 months after the DVA. The pDVA can be an option for limb salvage in patients with no‐option CLTI who are confronted by imminent amputation.https://doi.org/10.1002/ccr3.7589chronic limb threatening ischemiadeep venous arterializationend‐stage renal failurelimb salvage |
| spellingShingle | Tomonari Takagi Akira Miyamoto Norihiko Ohura Yasutaka Yamauchi Percutaneous deep venous arterialization with balloon angioplasty salvaged a life‐threatening critical limb in a hemodialysis patient after repeated pedal angioplasty failed: A case report Clinical Case Reports chronic limb threatening ischemia deep venous arterialization end‐stage renal failure limb salvage |
| title | Percutaneous deep venous arterialization with balloon angioplasty salvaged a life‐threatening critical limb in a hemodialysis patient after repeated pedal angioplasty failed: A case report |
| title_full | Percutaneous deep venous arterialization with balloon angioplasty salvaged a life‐threatening critical limb in a hemodialysis patient after repeated pedal angioplasty failed: A case report |
| title_fullStr | Percutaneous deep venous arterialization with balloon angioplasty salvaged a life‐threatening critical limb in a hemodialysis patient after repeated pedal angioplasty failed: A case report |
| title_full_unstemmed | Percutaneous deep venous arterialization with balloon angioplasty salvaged a life‐threatening critical limb in a hemodialysis patient after repeated pedal angioplasty failed: A case report |
| title_short | Percutaneous deep venous arterialization with balloon angioplasty salvaged a life‐threatening critical limb in a hemodialysis patient after repeated pedal angioplasty failed: A case report |
| title_sort | percutaneous deep venous arterialization with balloon angioplasty salvaged a life threatening critical limb in a hemodialysis patient after repeated pedal angioplasty failed a case report |
| topic | chronic limb threatening ischemia deep venous arterialization end‐stage renal failure limb salvage |
| url | https://doi.org/10.1002/ccr3.7589 |
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