Outcomes of Reintervention in Percutaneous Deep Venous Arterialization

OBJECTIVE: This study was performed to describe the outcomes of reintervention procedures for a stenotic or occluded percutaneous deep venous arterialization (pDVA) and to compare outcomes following pDVA in patients not requiring repeat intervention. METHODS: This was an observational case series with retrospective chart and radiology image review from January 2018 to July 2022. Sixty-two patients received pDVA using “off-the-shelf” devices. Baseline data including patient characteristics, time to reintervention, and technical success in reintervention were recorded. The primary endpoints were pDVA patency, wound healing, and amputation-free survival (AFS). RESULTS: Twenty-one cases (33.9%) qualified for reintervention. At the 1-month follow-up, 52.6% of patients had improved critical limb-threatening ischemia (CLTI; resolved rest pain or improvement/resolution of ulceration from baseline), with 57.9% experiencing wound healing. However, subsequent follow-up intervals demonstrated decreasing CLTI improvement and wound healing. Graft patency decreased at 1 month after secondary intervention to 41.2%. A Kaplan-Meier amputation analysis of reintervention vs non-reintervention demonstrated a nonsignificant difference in AFS at 6 months with a P-value of .05. CONCLUSION: Reintervention for stenotic or occluded DVA conduits provides further clinical improvement in the short term. Subsequent patency beyond 1 month shows a nonsignificant but clinically relevant difference in AFS overall for a 6-month period in the reintervention group compared to the non-reintervention group. Further studies are needed to validate these findings.