Great Saphenous Vein Arterialization in Patients with Severe Chronic Limb Threatening Ischemia: A Last Resort for Limb Salvage

Abstract

Background: In one-fifth of patients with chronic limb-threatening ischemia, there are no revascularization options. In those cases, venous arterialization could be a last resort for limb salvage. This study examines the clinical outcome of 17 patients with nonhealing wounds (Fontaine 4), who underwent great saphenous vein (GSV) arterialization, leaving the distal saphenous side branches open and avoiding incisions in the lower leg and foot.

Methods: In this retrospective study, all the patients who underwent GSV arterialization between January 1, 2020, and October 1, 2023, were included. During the procedure, a small incision was made in the groin to identify the GSV and superficial femoral artery. The GSV was detached from the deep venous system, the upper leg side branches were ligated, and the side branches distal to the knee joint were left open to create a pressure drop. Valvulotomy of the GSV down to the foot was performed in all patients. This approach does not necessitate the use of grafts or stents so that a severely infected foot can also be treated. For this study, we have analysed the limb salvage, wound healing, and mobility after treatment and observed preoperative and postoperative skin oxygenation over a 1-year period.

Results: This intervention resulted in a limb salvage rate of 46% and a secondary patency of 88% after 1 year in cases where amputation would have otherwise been necessary. Preoperative and postoperative TcPO2 measurements indicated a gradual but consistent increase in skin oxygenation in 71% of the patients with a GSV larger than 3 mm, highlighting the importance of future patient selection. All patients who successfully received arterialization achieved complete wound healing and improved mobility.

Conclusions: This study introduced a promising approach to venous arterialization in patients with severe chronic limb threatening ischemia who have no other treatment options, with the potential to significantly reduce disease burden and improve quality of life.