Percutaneous Deep Venous Arterialization for the Treatment of Buerger’s Disease

Abstract

Purpose: Percutaneous deep venous arterialization (DVA) using a stent-graft system is a novel endovascular approach in the treatment of patients with Buerger’s Disease.

Case Report: A 30-year-old male patient diagnosed with Buerger’s Disease presented with a painful, non-healing medial left hallux wound with ulceration. Lower extremity angiogram revealed extensive occlusion of all three tibial vessels in a pattern consistent with Buerger’s disease. Initially, revascularization and angioplasty of the posterior tibial artery was performed to supply flow but was occluded after one week, despite the patient being treated with aspirin and low molecular weight heparin. Since there was no suitable surgical target for bypass, the decision was made with the patient to perform deep venous arterialization to intervene. Percutaneous DVA was implemented to restore blood flow and to allow wound healing. The patient subsequently had a planned distal left hallux amputation which was non-healing. The decision was then made to perform a transmetatarsal amputation which then demonstrated
complete surgical wound healing.

Conclusion: A successful posterior tibial DVA ultimately resulted in resolution and revascularization. Deep venous arterialization serves as an alternative option to prevent above ankle amputation, to heal wounds, and to improve quality of life in patients with Buerger’s Disease.