1 Recommendations

Guidance

1.1 Percutaneous deep venous arterialisation for chronic limb-threatening ischaemia in people with limited treatment options should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.

1.2 Clinicians wanting to do percutaneous deep venous arterialisation for chronic limb-threatening ischaemia should:

Inform the clinical governance leads in their healthcare organisation.
Ensure that people (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these.
Take account of NICE's advice on shared decision making, including NICE's information for the public.
Audit and review clinical outcomes of everyone having the procedure. The main efficacy and safety outcomes identified in this guidance can be entered into NICE's interventional procedure outcomes audit tool (for use at local discretion).
Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve.

1.3 Healthcare organisations should:

Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for everyone having this procedure.
Regularly review data on outcomes and safety for this procedure.

1.4 Further research should report:

details of patient selection (including number of patients dependent on dialysis)
details of the procedure technique
duration of anticoagulation
patient outcomes (including planned and unplanned reintervention rate, major amputation rate, and quality of life).

Why the committee made these recommendations

The evidence is limited in quality and quantity; in particular, long-term data and quality of life data are lacking. The evidence includes different procedure techniques and different ways of selecting patients who have no other options for arterial revascularisation (restoring blood flow to a body part in which the blood vessels have become blocked). So, in people who have limited treatment options, this procedure can be used with special arrangements.