NICE has been notified about this procedure and it is part of its work programme. The Interventional Procedures Advisory Committee (IPAC) will consider this procedure and NICE will issue an interventional procedures consultation document about its safety and efficacy for 4 weeks’ public consultation. IPAC will then review the consultation document in the light of comments received and produce a final interventional procedures document, which will be considered by NICE before guidance is issued to the NHS in England, Wales, Scotland and Northern Ireland.
 
Status In progress
Process IP
ID number 1858
Description Critical limb ischaemia is a severe manifestation of peripheral arterial disease, and is characterised by severely diminished circulation, ischaemic pain, ulceration, tissue loss and/or gangrene. It is associated with high amputation, mortality rates and poor quality of life. This procedure aims to relieve ischaemic pain or wound healing without compromising the existing collateral circulation. Preoperative investigation (e.g. angiography, arterial and venous duplex scan) is needed to assess the vascular system and its blood flow. This procedure is usually done using general anaesthesia. An arterio-venous fistula is created between the great saphenous vein (GSV) and the appropriate donor artery, which is usually the popliteal artery. The GSV is then anastomosed end-to-side to the donor artery below the knee. Following valvulotomy, the arterial blood flows into the venous system and then towards the distal part of the venous circulation of the foot. All side branches of the GSV are ligated or embolised from the arterial anastomosis, usually until the anterior perforating vein of the malleolus. Completion angiography is done to visualise the perfusion of the foot through the superficial venous arch. This procedure arterialises the venous arch of the foot with GAS maintained in situ.

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For further information on how we develop guidance, please see our page about NICE interventional procedures guidance