Transcatheter arterialization of deep veins in a patient with no-option CLTI with thromboangiitis obliterans: A case report.

We report the first documented case of severe no-option ischemia due to thromboangiitis obliterans (TAO) successfully treated with transcatheter arterialization of deep veins (TADV). A 55-year-old man with TAO presented with a non-healing ulcer despite smoking cessation and multiple endovascular interventions. Owing to the absence of other revascularization options, TADV was performed using a modified venous arterialization simplified technique. A 5.0 × 250 mm covered stent graft was deployed from the tibioperoneal trunk to the distal posterior tibial vein, and valvotomy was performed with a 2.5-mm cutting balloon. Two weeks later, coil embolization was required to reduce a steal phenomenon from a plantar perforator vein. The TADV circuit remained patent for more than one year, with marked wound size reduction and successful limb salvage, although additional intervention for superficial femoral artery restenosis was required. This case suggests that TADV may offer a feasible therapeutic option for patients with TAO and no revascularization alternatives. While promising, further clinical experience and long-term data are needed to confirm its safety and efficacy in this unique patient population. Learning objective: Transcatheter arterialization of deep veins may enable limb salvage in patients with no-option severe ischemia due to thromboangiitis obliterans.