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Venous Arterialization Offers Limb-Saving Treatment for CLI

Advances in percutaneous endovascular techniques have greatly improved the capability to successfully treat CLI and avoid amputation. This is true even for older patients and those with severe comorbidities, including diabetes, renal failure and failed prior interventions. The sooner patients can be evaluated, the better chance there is to save the limb.

leg veinsAn increasing number of patients with critical limb ischemia (CLI) are not suited for standard distal arterial reconstruction. However, limb amputation is no longer the only option for these patients.

Inova’s vascular surgeons are among the first in the world to demonstrate that distal venous arterialization (DVA) can be a successful intervention for patients with CLI, in what otherwise have been viewed as unsalvageable “no-option” limbs. IHVI is one of just a few institutions performing this intricate procedure.

DVA establishes blood flow into the deep veins of the lower leg and foot to get blood to the tissues in a retrograde manner. Valves in the veins have to be disrupted so the blood flowing in a “reverse” direction is not stopped and can reach tissue through the capillary bed. This is accomplished using a bypass technique – distal vein bypass (DVP) – developed by Richard Neville, MD, Medical Director of Inova Vascular Services, Associate Director of IHVI and Chairman of the Department of Surgery.

As limb loss has profound implications for quality of life and long-term survival, it is worth exploring DVA as an alternative prior to amputation. Patients with ischemic rest pain, nonhealing wounds or gangrene, who have been told they have limited options for revascularization, are potential candidates for the procedure.

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