Postoperative Surveillance for Venous arterialization

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Introduction/Patient Description

Deep venous arterialization (DVA) is an increasingly common procedure performed in patients with limb-threatening critical ischemia (LTCI) where there are no open or percutaneous revascularization options. We aim to review the follow-up for venous arterialization described in the literature.

Methods

A systematic review was performed on DVA studies for LTCI using PRISMA methodology. A literature search was performed on 5 databases from inception. We included all publications regarding venous arterialization of lower extremity. We excluded abstract only, animal studies, and foreign language studies.

Results

Our search strategy yielded 16 studies that used Duplex imaging and 9 studies that used TcPO2 for follow-up. Only 9 studies provided any detail regarding the Duplex study. Two studies reported changes in systolic digital pressure (36.5 mmHg increase) and change in digito-brachial systolic pressure index (0.26 increase). One study used focal peak systolic velocity gradient above 2.5 as an indicator for flow-inhibiting venous valves or stenosis. One study reported peak systolic velocity in the graft (range 100-200 cm/sec). Two studies reported average flow through graft (50 – 165 mL/min). One case report reported pedal venous flow was 320 mL/min at 21 days and 437 mL/min at 25 days postoperatively. One study provided the description of flow pattern as turbulent flow with elevated peak velocities in the graft and more spectral broadening. Seven studies reported the mean increase in TcPO2 ranged from 10 to 48 mmHg. Two studies reported the percentage of patients with increased TcPO2 (67% and 88%). One study only reported postoperative TcPO2 which correlated with clinical deterioration. To date, no criteria had been identified for predictive of failure of DVA.

Conclusion/Discussion

DVA is an increasingly common procedure in the “no-option” diabetic patient. Duplex imaging with TcPO2 offers the most appropriate means of surveillance; however, the literature is sparse with no guidance on normal or critical values.

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Presented by

Qi Yan, General Surgery Resident, UT Health San Antonio