深静脉动脉化治疗慢性肢体威胁性缺血的研究进展

Advances in deep vein arterialization for the treatment of chronic limb-threatening ischemia

摘要:

慢性肢体威胁性缺血（CLTI）是外周动脉疾病最严重的临床阶段，部分患者因远端血管广泛闭塞而无法接受常规血运重建，被称为无治疗选择患者，截肢风险极高。深静脉动脉化（DVA）通过建立动静脉通路，将动脉血流引入足部静脉系统，为此类患者提供了新的保肢策略。近年来，随着开放式、经皮及混合式DVA技术不断发展以及LimFlow等专用器械的应用，DVA治疗的技术成功率、保肢率及创面愈合率均明显提高。本文结合近年来国内外研究进展，对DVA的生理学基础、技术演进、临床疗效、器械发展及围手术期管理等方面进行综述，并分析不同技术路径的特点及目前存在的问题，以期为DVA在CLTI患者中的规范化应用及未来研究提供参考。

Abstract:

Chronic limb-threatening ischemia (CLTI) represents the most advanced stage of peripheral artery disease, and a subset of patients are considered "no-option" because conventional surgical or endovascular revascularization is not feasible. Deep vein arterialization (DVA) has emerged as a promising limb salvage strategy by redirecting arterial blood into the distal venous system to improve tissue perfusion. With the continuous evolution of open, percutaneous, and hybrid DVA techniques, together with dedicated devices such as the LimFlow system, encouraging improvements have been achieved in technical success, limb salvage, and wound healing. This review summarizes the physiological basis, technical evolution, clinical outcomes, device development, perioperative management, and current challenges of DVA. The advantages and limitations of different techniques are also discussed to provide evidence for optimizing clinical application and future research in patients with no-option CLTI.