ObjectivesChronic limb-threatening ischemia (CLTI) is the end stage of peripheral arterial disease, characterized by ischemic rest pain, non-healing ulcers, or gangrene.Up to 40% of patients lack distal targets for revascularization, often resulting in major amputation.Great saphenous vein arterialization (GSVA) with distal pedal vein valve disruption is a promising limb-salvage technique.We report 12-month amputation, pain, and wound-healing for patients with CLTI treated with GSVA between 2019-2024. MethodsFrom October 2019-August 2024, 20 limbs in 15 patients with unreconstructable CLTI underwent GSVA.The great saphenous vein was used in situ and anastomosed to the most distal patent artery, with central valvulotomy and peripheral valve disruption.Outcomes were assessed through chart review to August 2025. ResultsGSVA was technically successful in all cases without major operative complications.Patients were predominantly male (87%) with mean age 63 years; 87% had diabetes.Follow-up 12 months was available for 14 of 15 patients (19/20 limbs).One patient died 327 days post-GSVA without undergoing amputation.Among the 19 limbs with 12-month follow-up, below-knee amputation (BKA)-free survival was 53% (10/19).Over total study follow-up, BKA-free survival was 55% (11/20).In limbs without BKA, 91% demonstrated wound healing and pain improvement.Most amputations (8/9) occurred within 1.5 months of GSVA.
Shoemaker et al. (Sun,) studied this question.