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Author(s): Aigars Lacis*, Janis Savlovskis, Karlis Kupcs, Vladislavs Strods and Veiss Andris
Critical Limb Ischaemia (CLI) is the clinical end stage of Peripheral Artery
Disease (PAD) associated with a high risk of major amputation, cardiovascular
events, poor quality of life and death. Bypass surgery and/or endovascular
interventions are the first-line treatment of choice in these cases to prevent
amputation and resolve rest pain. Other treatment methods are either in the study phase (gene and stem cell therapy) or have little or no effect (vasoactive
therapy or spinal cord stimulation). Unfortunately, about 15%-20% of CLI
patients are not candidates for distal revascularization because of a lack of
target outflow vessels. Surgical Deep Venous Arterialization (DVA) provides
reverse flow to the capillary beds and increases collaterals. DVA may be
considered as a viable alternative before major amputation in patients with
CLI due to an unreconstructable lower extremity arterial disease.
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