Deep Vein Arterialization May Help Some People with “Desert Foot” Avoid Amputation
Interventional radiologist James Ronald, MD (left), and vascular surgeon Kevin Southerland, MD (right), stand in an operating room used for deep vein arterialization.
People with a severe form of peripheral artery disease called “desert foot” who are headed for amputation may have another option at Duke. Deep vein arterialization surgery, a complex procedure only offered at a handful of centers in North Carolina, bypasses irreversibly blocked arteries by hijacking nearby veins to deliver oxygenated blood to the lower leg. “No one ever wants to lose a limb, but we ultimately want our patients to have the best quality of life possible,” said Duke vascular surgeon Kevin W. Southerland, MD. “Deep vein arterialization may not be able to deliver that for everyone. For some, this procedure has the potential to affect what their future looks like.”
Peripheral Artery Disease and Desert Foot
Peripheral artery disease (PAD) occurs when the arteries in your legs become narrowed or blocked. About 10% of people with PAD progress to chronic limb-threatening ischemia (CLTI). Lack of blood flow causes significant leg pain (even at rest), slow-healing wounds or skin ulcers, and gangrene in the feet. When there is no viable option to treat or repair the diseased arteries, doctors call it “no-option chronic limb threatening ischemia” or “desert foot.” Your doctor may say amputation is your only treatment option.
Amputation Alternative: Deep Vein Arterialization Explained
Deep vein arterialization surgery reroutes blood flow around clogged arteries by repurposing veins to circulate oxygen-rich blood. “Your body has two types of highways,” Dr. Southerland said. “Arteries transport blood from your heart to your legs and feet. Meanwhile, veins move blood in the opposite direction, back to the heart.”
When there’s a pile-up on the highway that cannot be cleared, the only remaining option is to divert traffic, Dr. Southerland explained. “Instead of a highway going northbound, we make it go southbound.”
Deep vein arterialization surgery is broken down into two main parts. First, doctors connect an artery and a vein. Then they remove valves from inside the vein that prevent blood from flowing backward.
Am I Eligible for Deep Vein Arterialization?
To be eligible for deep vein arterialization, you must:
- Have exhausted all other treatment options.
- Be healthy enough to undergo surgery and general anesthesia.
- Be able and willing to attend frequent follow-up appointments.
- Be able to take blood thinning medications for life.
- Have favorable anatomy.
Setting Expectations
Dr. Southerland cautioned against thinking of deep vein arterialization as a magic wand. The nature of desert foot makes it extremely difficult to treat. Successfully rerouting blood flow is only part of the equation. “The tricky part is whether the vein arterializes quickly and facilitates enough circulation to heal your foot before it’s too late,” explained Dr. Southerland. “That success rate is between 30% to 50%. For someone who desperately wants to save their foot, deep vein arterialization is worth trying.”
Choose Duke for Deep Vein Arterialization
Duke offers a traditional surgery and minimally invasive approach, also known as a transcatheter or endovascular technique, for deep vein arterialization. Your care team will recommend the option that gives you the best chance of success.
For transcatheter cases at Duke, vascular surgeons like Dr. Southerland team up with interventional radiologists. “You really need four functional hands to do this, because it requires a lot of skill,” Dr. Southerland said. “At times you're working inside of blood vessels that are only two millimeters wide.” Having two surgeons working together also makes the procedure faster, so patients spend less time under anesthesia.
As a Duke patient, you also benefit from critical diagnostic tools like duplex ultrasound and specialized technicians trained to catch early signs of arterialization failure. Duke also offers robust amputation and limb loss counseling and other support services to help you decide whether deep vein arterialization is right for you.
