Open Superficial Venous Arterialization for Limb Salvage.

BACKGROUND

Patients with chronic limb threatening ischemia (CLTI) unsuitable for conventional endovascular or surgical revascularization are treated with major amputation. Superficial venous arterialization (SVA) presents an alternative option. No cases report success beyond 2 years.

METHODS

Retrospective review of patients undergoing SVA between 2019 and 2023 by 2 surgeons in a regional vascular unit. The primary end point was limb salvage. Presentation, comorbidities, and symptom resolution were recorded. Patients were followed up clinically and with duplex ultrasound.

RESULTS

Five patients underwent open lower limb SVA using the Lengua technique. Indications were tissue loss in 4 and severe ischemic rest pain in 1. Median age was 68 (range 50-71) years, 2 were female. Median follow-up was 5 months (range 1-36) with the longest ever reported follow-up at 3 years. Eighty percent were technically successful. Limb salvage rate was 40%, rest pain resolved and wounds healed in both. The other three had amputations - 2 transtibial and 1 transfemoral. Of these, one patient had a functioning graft but no benefit in perfusion or pain and requested amputation.

CONCLUSION

SVA offers an unconventional but simple option for limb salvage for younger, fitter patients with CLTI. Key technical considerations, prerequisite anatomy and reasons for failure are described.