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Describing The Histopathological Effects Of Transcatheter Arterialization Of Deep Veins In Chronic Limb Threatening Ischemia
Alexander B. Crichton, MBChB, MS
1, Judit Csore, MD, PhD
1, Bright Benfor, MD
1, Deborah Vela, MD
2, Miguel Montero-Baker, MD
3, Trisha Roy, MD, PhD
1.
1Houston Methodist Research Institute, Houston, TX, USA,
2Texas Heart Institute, Houston, TX, USA,
3Houston Methodist Hospital, Houston, TX, USA.
OBJECTIVES:Deep venous arterialization (DVA) is reserved for “no option for revascularization” chronic limb threatening ischemia patients [1]. There is however little evidence to explain the physiological and histological changes that occur after DVA. The aim of this study was to describe the histological changes that occur in the below knee vasculature after DVA.
METHODS:In this single center study, all patients that had undergone DVA and proceeded to transmetatarsal or above ankle amputation were included. Baseline demographic data were prospectively collected. Once the limb had been amputated, the available vessels were harvested and assessed by a pathologist.
RESULTS:Between 06/01/2023 and 03/31/2024, five patients (2 male, 3 female) with a median age of 65 years were included in the study. 80% of patients had undergone previous intervention on the affected limb and 40% had previously had contralateral major limb amputation. Median time from DVA to amputation was 21 days (4-137). In the day 4 sample, evidence of chronic total occlusion of the lateral plantar but even at this early stage, some neointimal hyperplasia of a vein was seen. In the day 21 samples, there was more evidence of neointimal hyperplasia across multiple samples of the lateral plantar veins. In the patients who were over four months post DVA, samples were collected just distal to the site of the stent. There was further evidence of venous intimal hyperplasia across both small and large veins. There was also however increased matrix deposition and fibrosis which was not seen in earlier samples (figure 1).
CONCLUSIONS:This study shows a timeline of the histopathological effects DVA has on the venous system post-operatively, with evidence of venous neointimal hyperplasia as early as day 4. More widespread findings were identified across the venous samples as the vasculature had more time to mature. An important finding was the late matrix deposition and fibrosis found just distal to the stent in the posterior tibial vein. This has significant clinical implications given that it is a common site requiring reintervention. To our knowledge, this study describes the first case series that outlines the histopathological effects of DVA on the distal venous circulation.
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