The Massachusetts General Hospital Approach to Transcatheter Arterialization of the Deep Veins for Advanced Limb Salvage: Protocols and Procedures

Contents
Editors and Contributors
About the Editors
Contributors
Part I: Patient Identification
	1: Selecting the Correct Patient Candidate
		1.1	 Profile of a TADV Patient
		1.2	 Major Considerations
	2: Evaluating the Angiogram
		2.1	 Stoplight Approach to Angiographic Screening
		2.2	 Tibial Donor Vessel Evaluation
	3: Preprocedural Wound Considerations
		3.1	 How to Identify Appropriate Wounds
			SVS Wound (W) Category
				Wound Grade 1, An Appropriate Candidate (Fig. 3.1)
				Wound Grade 2, Additional Considerations Required (Fig. 3.2)
				Wound Grade 3, Additional Considerations Required (Fig. 3.3)
			SVS Foot Infection (fI) Category
				Foot Infection Grade 0, An Appropriate Candidate (Fig. 3.4)
				Foot Infection Grade 1, An Appropriate Candidate (Fig. 3.5)
				Foot Infection Grade 2, Additional Considerations Required (Fig. 3.6)
				Foot Infection Grade 3, TADV Not Advisable (Fig. 3.7)
		3.2	 Stop Light Approach to Wound Screening, WIfI
		3.3	 Stop Light Approach to Wound Screening, Location (Fig. 3.11)
		3.4	 Pre-TADV Wound Stability
			Scenario #1
			Scenario #2
			Scenario #3
	4: Explaining TADV to the Patient and Family
Part II: Patient Preparation
	5: Duplex Pedal Mapping for Case Preparation
		5.1	 Introduction
			Purpose
			Indications and Limitations
			Equipment
			Patient Prep
			Procedure
		5.2	 Required Documentation
			Venous
			Arterial
			Mapping
		5.3	 Interpretation
			Venous
	6: Preoperative Optimization of the Patient
		6.1	 History
		6.2	 Physical Examination
		6.3	 Optimizing Medical Conditions
		6.4	Investigations
		6.5	Antithrombotic Therapy
Part III: Procedure and Acute Post- operative Care
	7: Overview of TADV and Required Equipment
		7.1	 Anatomical Considerations
		7.2	 Equipment
	8: Pedal Venous Access
		8.1	 Required Knowledge Base
		8.2	 Preoperative Pedal Venous Ultrasound
		8.3	 Recommended Products
	9: Procedural Steps
		9.1	 Case Preparation
		9.2	 Pedal Access and Interventional Techniques (Fig. 9.2)
		9.3	 Venous Access Watch Outs and Tips
		9.4	 Femoral Access
		9.5	 Crossing Preparation
		9.6	 Artery to Vein Alignment: C-Arm Positioning
			Primary Alignment Method: Eclipse View and 90° Offset
			Secondary Alignment Method: Maximum Distance
			After Confirming the Correct C-Arm Position
			Crossing Needle Deployment: With the Arterial Catheter (ARC) Aligned to the Target Vein
			Artery to Vein Crossing: Advance Crossing Guidewire (Fig. 9.16)
			Artery to Vein Crossing: Guidewire Capture (Fig. 9.17)
			Artery to Vein Crossing: Guidewire Externalization
			Dilating the Conduit (Fig. 9.18)
		9.7	 Crossing Watch Outs and Tips
		9.8	 Valve Effacement
		9.9	 Stent Deployment (Fig. 9.20)
			Pedal Loop Wiring
			End of Case
	10: Immediate Postoperative Care
		10.1	 Expectations After TADV
		10.2	 Post-Procedure Care
		10.3	 Wound Care
	11: Post-TADV Care Plan
Part IV: Post-procedure Care and Maintenance
	12: Imaging the TADV Circuit
		12.1	 Duplex Ultrasound Surveillance
		12.2	 Limitations
		12.3	 Equipment
		12.4	 Patient Prep
		12.5	 Procedure
		12.6	 Required Documentation
		12.7	 Volume Flow Rate Considerations (Fig. 12.1)
		12.8	 Interpretation
	13: Circuit Maintenance and Optimization
		13.1	 Indications for Intervention Post-TADV
		13.2	 Flow Optimization
			Nutritive vs Non-nutritive Flow in the Foot
			Non-nutritive Flow Imaging Characteristics
		13.3	 Symptoms of Non-nutritive Flow
			Clinical Signs of TADV Circuit Compromise
		13.4	 Flow Management Post-TADV
		13.5	 Flow Management Timing
			Key Indications for Intervention
			Changes in Blood Flow Characteristics and TADV Maturation Are Rapid in the Initial Weeks after TADV
			Timing
		13.6	 Volume Flow Interpretation
	14: Wound Care
		14.1	 Day 0–90 Post-TADV
		14.2	 Treatment Plan Strategy for Infected Wounds
	15: TADV and Beyond: Postoperative Care of the Patient with Forefoot Amputation
		Variations on Final TADV Imaging
		References
Index