Hybrid approach to deep vein arterialization as an adjunct for patients with severe medial calcinosis

Patients with "no-option" chronic limb-threatening ischemia (noCLTI) are not candidates for conventional revascularization options and will inevitably require major amputation. Deep venous arterialization (DVA) is a potential option for these patients. A complete endovascular system to perform DVA has recently received great acclaim and FDA approval. However, patients with severe tibial medial calcinosis such as those with diabetes or renal failure may not be candidates for this as most endovascular needles cannot penetrate severe calcium. Here we describe a novel hybrid approach to DVA that provided technical success in three patients with end stage renal disease and severe medial calcinosis.