A 5-year limb salvage for long-term limb salvage in chronic limb-threatening ischemia without options for revascularization, utilizing a hybrid deep venous arterialization technique: A case report

Chronic limb-threatening ischemia represents the most severe form of peripheral arterial disease, with a 40% amputation rate and 20% mortality at 6 months without revascularization. Deep venous arterialization is an alternative for patients with advanced peripheral arterial disease who have no conventional revascularization surgery option based on their anatomy-no distal artery target to redirect arterial blood. Hybrid deep venous arterialization, which combines open surgical bypass with venous endovascular arterialization and valvulotomy, is a technique under investigation for limb salvage with limited current long-term data. We present a successful limb salvage case report of an early 60s male with no conventional revascularization options who presented with a wound in his foot and underwent a successful hybrid deep venous arterialization. The hybrid deep venous arterialization technique has shown promising preliminary results for long-term limb salvage at 5 years after surgery. This case report establishes a tangible example of the potential role of hybrid deep venous arterialization in the management of patients with no-option chronic limb-threatening ischemia. After a 5-year follow-up, the reported patient has no ischemic symptoms, and he is able to ambulate without support.