Postprocedural Management in Patients After Percutaneous Deep Venous Arterialization: An Expert Opinion

Abstract

Deep venous arterialization (DVA) is a new and developing technique with promising outcomes. The DVA procedure can be performed surgically in a hybrid fashion or percutaneously. Over the last years, the hybrid and percutaneous techniques have been further developed and have become a focus of many DVA studies. Between 2017 and 2021, 5 different percutaneous deep venous arterialization (pDVA) techniques, and 2 hybrid procedures have been investigated. In total, 9 cohort studies and 2 case reports have been performed to evaluate their outcomes. Understandably, these studies mainly focused on the technique, patency, and outcomes after DVA. However, postprocedural management can be as challenging as the procedure itself but has not been a priority for further investigation. This review summarizes the different techniques proposed, and the follow-up care provided in literature. Follow-up care includes postoperative medication, edema occurrence and treatment, pain management, patency assessment, reintervention techniques, a staged amputation strategy if necessary, and appropriate wound care. Evidence from literature and own clinical experience was combined to provide recommendations for care after DVA. Clinical Impact: After percutaneous deep venous arterialization (pDVA), the created arteriovenous circuit needs time to develop. Postprocedural care in patients after pDVA is essential in order to create optimal conditions for maturation of the circuit, and thus save the limb. However, current literature mainly focusses on the procedure itself, making postprocedural care an underexposed topic. Therefore, this study presents an overview of the available literature of postprocedural care of pDVA patients and provides recommendations based on expert opinion when current knowledge is limited.