Saving Lives and Limbs: Inova Heart and Vascular Institute Advances Techniques to Treat Chronic Limb-Threatening Ischemia

New Intervention Can Prevent Amputations

Vascular surgeons at Inova Heart and Vascular Institute (IHVI) are among the first in the world to demonstrate that a technique called distal venous arterialization (DVA) can be a successful intervention for patients with chronic limb-threatening ischemia (CLTI) in limbs that otherwise might be viewed as unsalvageable. IHVI is one of just a few medical institutions anywhere in the world performing this intricate procedure.

Patients who have been told they have limited options for restored blood flow are potential candidates for the procedure.

Ischemia is a serious condition in which there is inadequate blood flow and oxygen to various parts of the body. In the limbs, it can cause severe tissue damage, including skin ulcers and gangrene. CLTI, an advanced form of peripheral arterial disease (PAD), is a medical emergency that brings significant risk of complications and death. Rapid diagnosis and treatment is required to restore blood flow to the extremity and prevent complications that could lead to amputation. (PAD is also referred to as Peripheral Vascular Disease.)

“Advances in percutaneous endovascular techniques have greatly improved our capability to treat CLTI and avoid amputation. This is true even for older patients and those with severe comorbidities, including diabetes, renal failure and failed prior interventions,” said Richard Neville, MD, Associate Director of IHVI, System Division Chief of Vascular Surgery and Chairman of the Department of Surgery.

Many patients suffer from PAD associated with diabetes or atherosclerosis (hardening of the arteries). PAD progresses more rapidly in patients with diabetes, and their risk of developing CLTI is four times higher.

An increasing number of patients with CLTI are not suited for the standard surgical technique to restore blood flow, called distal arterial reconstruction. However, limb amputation is no longer the only option for these patients.

DVA is an alternative procedure that reestablishes blood flow into the deep veins of the lower leg and foot to get blood to the tissues. Valves in the veins are disrupted so the blood flowing in a “reverse” direction is not stopped and can reach tissue through the capillary bed. This is accomplished in combination with a bypass technique – distal vein patch bypass – that was developed by Dr. Neville.

“As limb loss has profound implications for quality of life and long-term survival, DVA should be considered as an alternative prior to amputation when standard techniques are not possible,” says Dr. Neville. “Patients with ischemic rest pain, nonhealing wounds or gangrene who have been told they have limited options for restored blood flow are potential candidates for the procedure.”

Vascular and Vein Doctors in Northern Virginia

Inova Vascular has seven outpatient offices located throughout Northern Virginia including locations in Alexandria, Falls Church, Fairfax/Fair Oaks, Mount Vernon, Manassas and Woodbridge. Vascular diagnostics and imaging services are available in all the outpatient offices, and the vascular surgeons provide services at all five Inova hospitals. Visit to learn more.

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