Simplified Endovascular Deep Venous Arterialization for Non-option CLI Patients by Percutaneous Direct Needle Puncture of Tibial Artery and Vein Under Ultrasound Guidance (AV Spear Technique)

  • Shigeo IchihashiEmail author
  • Yuichi Shimohara
  • Francesco Bolstad
  • Shinichi Iwakoshi
  • Kimihiko Kichikawa
Case Report


The following case report describes the AV spear technique for percutaneous deep venous arterialization. After an ultrasound survey was performed to find the puncture point adjacent to the ankle joint where the posterior tibial vein (PTV) runs superficially to the posterior tibial artery (PTA), percutaneous penetration of the PTV and PTA was conducted. Then a microguidewire was inserted from the distal puncture site into the PTA and advanced into the arterial sheath, establishing a through-and-through wire. A microcatheter was then advanced antegradely over the through-and-through wire. After removing the wire, a hydrophilic guidewire was utilized in order to identify the venous lumen. Finally, a balloon angioplasty was conducted to create an AV fistula, which was reinforced by stent placement.


Percutaneous deep venous arterialization Endovascular procedures Peripheral arterial disease 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Consent for Publication

Consent for publication was obtained for the person’s data included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2019

Authors and Affiliations

  1. 1.Department of RadiologyNara Medical UniversityKashiharaJapan
  2. 2.Department of Clinical EnglishNara Medical UniversityNaraJapan

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