How do experienced operators approach the most technically demanding aspects of deep venous arterialization (DVA)? In this episode of BackTable, host Dr. Sabeen Dhand sits down with Dr. Kumar Madassery for a detailed discussion of procedural strategy, technical decision-making, and real-world troubleshooting in DVA.

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SYNPOSIS

Dr. Madassery walks through his approach from pre-procedure planning to final scaffolding. The conversation begins with imaging review, patient selection, and anesthesia considerations, emphasizing how preparation influences technical success. They then examine venous mapping and access strategy, with specific attention to femoral and tibial disease patterns and how these anatomic variables shape crossing techniques.
This episode also covers wire and catheter selection, techniques for creating the arteriovenous anastomosis, balloon sizing, valve management, and stent scaffolding. Throughout, Dr. Madassery shares practical solutions to common access challenges and highlights decision points that can determine procedural durability. The discussion closes with reflections on clinical management, operator fatigue, and the value of professional networks when navigating complex limb salvage cases.

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TIMESTAMPS

00:00 - Introduction
03:08 - Pre-Procedure Imaging and Setup
05:01 - Venous Access and Mapping
07:27 - Anesthesia and Patient Preparation
12:29 - Femoral and Tibial Disease Considerations
23:17 - Crossing Techniques and Tools
27:16 - Venous Access Challenges and Solutions
35:54 - Creating the Anastomosis
37:03 - Balloon Sizing and Scaffolding Techniques
38:26 - Navigating Venous Access Challenges
39:56 - Wire and Catheter Strategies
42:08 - Dealing with Valves and Anastomosis
44:16 - Proximal vs. Distal DVA Approaches
47:01 - Scaffolding and Stent Techniques
50:06 - Clinical Management and Case Fatigue
01:01:10 - Networking and Seeking Advice
01:05:41 - Concluding Thoughts and Future Directions