Anterior tibial artery to anterior tibial vein deep venous arterialization in a chronic limb-threatening ischemia patient with long-term limb preservation

Deep venous arterialization (DVA) is increasingly utilized globally for patients with chronic limbthreatening ischemia (CLTI) without alternative revascularization options. [1]A major challenge is small artery disease pattern or "desert foot, " where poor tibiopedal outflow precludes arterial revascularization.Prospective DVA trials (Promise I/II) report approximately 70% amputationfree survival (AFS) at 1 year. [2,3]However, outcomes are worse in end-stage renal disease (ESRD), with only 36.8%AFS at 6 months in Promise II. [3] Most reported DVAs utilize the posterior tibial artery/posterior tibial vein (PTA/PTV) due to its favorable access and anatomy. [1]Alternative conduits include the peroneal or tibioperoneal trunk.e anterior tibial artery/anterior tibial vein (ATA/ATV) conduit is less commonly utilized due to its superficial course and variable outflow anatomy.Nonetheless, ATA/ATV may be a viable option when other conduits are unsuitable.