Homemade Device to Facilitate Percutaneous Venous Arterialization in Patients With No-Option Critical Limb Ischemia

J Endovasc Ther . 2019 Apr;26(2):213-218. doi: 10.1177/1526602819830983. Epub 2019 Feb 15.

Fecha de la publicación: 15/02/2019

Autor: August Ysa (1), Marta Lobato (1), Ederi Mikelarena (2), Amaia Arruabarrena (1), Roberto Gómez (1), Ana Apodaka (1), Matthew Metcalfe (3), Juan L Fonseca (1)

Palabras clave: Arteriovenous fistula, Balloon catheter, Critical limb ischemia, Desert foot; no-option CLI, Plantar vein, Snare, Tibial artery, Venous arterialization.



1 Vascular Surgery Department, Hospital de Cruces, Barakaldo, Spain.

2 Vascular Surgery Department, Hospital Donostia, Spain.

3 Vascular Surgery Department, Lister Hospital, Stevenage, UK.


Purpose: To describe a maneuver to facilitate percutaneous arteriovenous fistula creation during venous arterialization procedures in patients with no-option critical limb ischemia.

Technique: Following a failed arterial recanalization attempt, a balloon catheter is passed up to the tip of the guidewire. Venous access is gained distally, a 4-F sheath is antegradely passed, and a 4-mm GooseNeck snare is advanced through it. A fluoroscopic view that overlaps the snare and the inflated balloon is obtained. If the vein remains anterior with respect to the artery, a needle is inserted across the vein, passing through the snare loop and puncturing the intra-arterial balloon. A wire is inserted and placed inside the punctured balloon. The balloon is retrieved and the wire externalized through the femoral access. A catheter is advanced antegradely over this wire from the artery into the vein. If the vein remains posterior to the artery, a needle is inserted, puncturing the balloon and thereafter the vein (crossing through the snare). A wire is inserted, captured by the snare, and externalized through the vein sheath. A catheter is finally advanced over this wire from the vein into the artery.

Conclusion: This maneuver is a simple alternative to create an arteriovenous fistula during venous arterialization procedures in patients with no-option critical limb ischemia.