Patterns of Failure in Deep Venous Arterialization and Implications for Management

Objective. The primary objective of this study was to describe a novel classification system to characterize patterns of failure in deep venous arterialization (DVA) and suggest intervention strategies that correlate with these patterns. Methods. This was an observational case series with retrospective chart and radiology image review. Data including time between initial DVA and reintervention, location of failure relative to DVA site, and corresponding reintervention strategies were recorded. The primary endpoints measured were the frequency of failure patterns and reintervention strategies employed. Results. Sixty-seven DVAs were performed in this cohort using commercially available devices. Twenty-five cases (37.9%) required reintervention. From the reintervention cases, two-thirds presented with multiple failure patterns simultaneously; 68.0% of repeat cases involved venous outflow failure while 56.0% of cases involved arterial inflow lesions. Strategies used in our cohort of 23 reintervention cases included drug-coated balloon or percutaneous transluminal angioplasty (72.0%), additional stent deployment (60.0%), or additional graft placement (8.0%). Discussion. Based on the results, we propose a classification of “failure type” patterns as one or a combination of the following based on the occlusion site found during reintervention, including arterial inflow, intragraft, transitional vein (proximate to distal edge of stent graft), venous arch, and/or undefined. In these cases, angioplasty, additional stent deployment, and/or additional graft placement can be used in reintervention according to our model. Conclusion. DVA failures and reinterventions are common. It is possible to identify patterns and related treatments using our classification system. Further studies are needed to validate our model.