Fluoroscopic and Ultrasound Criteria for Patient Selection in DVA

During her Saturday presentation on DVA Day at the Amputation Prevention Symposium, Abigail Mize, BS, RDCS, RVT, from AMize Consulting Services LLC in Grand Rapids, Michigan, provided an overview of selecting patients for deep vein arterialization (DVA) based on imaging criteria. 

First, Ms. Mize looked at patient selection criteria. The target patient population includes those classified as Rutherford Class 4, 5, or 6, who show signs of advanced lower extremity ischemia with evidence of complete or near-complete blockage of distal tibial and pedal/plantar arteries. Key factors include the absence of salvageable native plantar arteries and the presence of microvascular disease, particularly when traditional endovascular and surgical methods have failed to restore sufficient blood flow to the foot.

She then reviewed angiographic imaging characteristics, explaining that on angiography, these patients exhibit a lack of visible native vessel pathways. The imaging often reveals numerous string-like or irregular collateral vessels, and a notable feature is the "desert foot" appearance, where proximal tibial flow is typically maintained, but the flow to the plantar region is severely compromised.

Ultrasound imaging characteristics came next; ultrasound findings for these patients may show vessels that are completely opacified with calcium or absent due to severe atresia. There is often no visible vessel lumen or discernible vessel layers, with significant acoustic shadowing present.

In conclusion,  Ms. Mize emphasized the importance of recognizing these specific imaging landmarks to accurately identify patients who would benefit from DVA. Proper identification ensures that these patients receive the most appropriate and potentially beneficial interventions.