Venous arterialization is the novel and last resort procedure for patients presenting with critical limb ischemia (CLI) due to atherosclerosis and without other standard revascularization options. There are few studies on its outcomes across the globe. In these cases, aggregate metanalysis can obviate the need for a large clinical trial. We aim to review and analyze outcomes of venous arterialization.
A systematic review and meta-analysis was performed on original venous arterialization studies for CLI using PRISMA methodology. Literature search was performed on 5 databases from inception based on previous published strategy. Inclusion criteria were English language studies, human subjects, reporting outcome of interest. Exclusion criteria: other than atherosclerosis, duplication, abstract only.
Out of 609 titles total, 362 were unique, and 21 articles met inclusion criteria. A total of 341 (average age 67, range 37-94, 83% male) patients underwent venous arterialization. Seven studies described open deep vein arterialization (DVA) (127 patients), 6 studies described percutaneous DVA (43 patients), 5 studies described great saphenous vein arterialization (137 patients), and 1 study described hybrid DVA (25 patients). Technical success ranged from 78% to 100%, 30-day or intrahospital mortality ranged from 0-20%, 30-day or perioperative morbidity ranged from 0-37%. Pooled 30-day or postoperative major adverse cardiovascular events (MACE) was 5.6% (95% CI 1.1%-10.1%), below objective performance goal (OPG) of 10%. Overall pooled limb salvage was 69.3% (95%CI 51.4%-87.2%) over average 11-month follow-up. Pooled 1-year limb salvage rate was 73.9% (95%CI 67%-80.9%), slightly low than OPG of 81%. Two-year limb salvage rate was 59.% (95%CI 18.9%-100%).
Venous arterialization is an acceptable last resort procedure for CLI patients without revascularization options with 1-year limb salvage rate of 74%. Conservative management with optimal wound care has been shown to have only < 50% limb salvage rate. Aggregate meta-analysis is a successful mechanism to speed acceptance of novel techniques.
Qi Yan, General Surgery Resident, UT Health San Antonio