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Abstract Background No option- CLTI constitutes up to 20% of patients who are not candidates for revascularization and have a high risk of limb loss (40%) without further intervention. pDVA is an endovascular procedure for patients with no option- CLTI, where arterial blood is channelled into the tissues via the venous network. We present two such cases with varying presentations. Case presentation A 52-year gentleman presented with bilateral Diabetic Foot infection and CLTI. CT Angiogram demonstrated bilateral occlusive Tibial disease. While the right leg underwent a major amputation, the MDT felt that although there were no arterial revascularisation options, pDVA was possible. This was successful with significant improvement in the foot. Four months post -procedure the foot had extensive dry gangrene with good Lateral Plantar doppler signals. Trans- metatarsal amputation and debridement followed by a Split- thickness skin graft was performed. At 8 months post- pDVA, the foot has healed well. Another 65-year gentleman presented with left sided Rutherford Category 5 CLI. CT Angiogram concluded occlusive distal Tibial disease. He underwent Tibial angioplasty which soon re-occluded. Based on follow-up scans, the MDT declared him suitable for pDVA which was successful. Four weeks post- operatively the foot showed extensive necrotic tissue. Trans- metatarsal amputation followed by Split- thickness skin graft was performed. At 1- year post- pDVA, the foot has healed well. Discussion pDVA should now be considered for all patients with CLTI that are anatomically suitable, as it can be performed with high degree of procedural success to promote wound healing and prevent major amputations.
Mishra et al. (Mon,) studied this question.