This presentation provides a comprehensive, hemodynamic-focused overview of deep venous arterialization (DVA) and hybrid arterialization for poor-to-no option patients with chronic limb-threatening ischemia. Emphasis is placed on disease-pattern recognition to help vascular sonographers identify patients who may benefit from venous or open arterialization approaches when conventional revascularization options are exhausted.

The talk outlines duplex-based criteria that should prompt automatic pedal venous mapping, including specific arterial flow patterns, distal hemodynamic findings, and pedal perfusion characteristics. Pre-procedural venous mapping strategies are reviewed with attention to identifying suitable venous targets and access pathways to support procedural planning.

Post-arterialization surveillance is discussed in detail, extending beyond assessment of patency and flow volume. Sonographers will learn to evaluate non-donor arterial peak systolic velocities, resistive index changes in the popliteal artery, pedal venous maturation, venous Pedal Acceleration Time (vPAT), and arterial PAT as complementary physiologic markers of successful perfusion and maturation. These parameters provide critical information on evolving hemodynamics and limb viability following arterialization.