Arterial Gerrymandering — Converting Veins to Arteries to Save Ischemic Limbs

This editorial introduces transcatheter arterialization of deep veins, a novel approach for patients with no conventional revascularization options in chronic limb-threatening ischemia. The PROMISE II study evaluated this endovascular procedure, which diverts oxygenated arterial blood into venous circulation by connecting the leg artery and vein via covered stents. Among 105 patients facing major amputation, 99% had procedural success, and 66.1% achieved amputation-free survival at 6 months. Outcomes were poorer in dialysis-dependent patients. Although the technique requires technical expertise and repeat interventions to maintain vessel patency, it represents a promising alternative for limb salvage in otherwise untreatable cases.

This editorial introduces transcatheter arterialization of deep veins, a novel approach for patients with no conventional revascularization options in chronic limb-threatening ischemia. The PROMISE II study evaluated this endovascular procedure, which diverts oxygenated arterial blood into venous circulation by connecting the leg artery and vein via covered stents. Among 105 patients facing major amputation, 99% had procedural success, and 66.1% achieved amputation-free survival at 6 months. Outcomes were poorer in dialysis-dependent patients. Although the technique requires technical expertise and repeat interventions to maintain vessel patency, it represents a promising alternative for limb salvage in otherwise untreatable cases.