{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T09:17:15Z","timestamp":1789463835836,"version":"build-2803163510"},"reference-count":15,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":257,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Medicine"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In no\u2010vein chronic limb\u2010threatening ischemia (CLTI), infrapopliteal prosthetic bypass remains a limb\u2010salvage option but is limited by high distal resistance and graft\u2010artery compliance mismatch. Standard distal adjuncts, including vein cuffs, patches, or distal arteriovenous fistulas, may be technically demanding when local tibial venous anatomy and the confined distal exposure do not allow a reliable conventional configuration. We describe a compact heel\u2010site bypass\u2010to\u2010vein vent based on direct end\u2010to\u2010side venous reimplantation onto the PTFE graft immediately proximal to the arterial heel.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>A controlled heel\u2010site arteriovenous vent was created immediately proximal to the arterial heel of a distal polytetrafluoroethylene (PTFE)\u2013anterior tibial artery (ATA) anastomosis in a 75\u2010year\u2010old man with recurrent CLTI, prior failed revascularizations, no usable autologous conduit, and single\u2010vessel tibial runoff through the ATA. Intraoperative assessment showed paired deep veins accompanying the ATA of approximately 2.0\u20132.5\u2009mm in external diameter with thin walls, making a conventional distal AVF\/interposition configuration technically unfavorable. A calibrated oval venotomy was fashioned on the distal PTFE graft, and the proximal stump of the anterior tibial vein was reimplanted end\u2010to\u2010side onto the graft with an oblique takeoff to create a short, controllable bypass\u2010to\u2010vein vent.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Postoperative computed\u2010tomography angiography and serial duplex ultrasound surveillance demonstrated sustained patency of both the PTFE\u2013ATA bypass and the heel\u2010site vent, without hemodynamically significant stenosis, excessive shunting, venous hypertension, distal steal, graft thrombosis, or reintervention at 6\u2009months. Rest pain resolved, and baseline ambulation was restored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This heel\u2010site arteriovenous vent represents a compact, calibratable bypass\u2010to\u2010vein configuration that differs from conventional distal AVF adjuncts by using direct end\u2010to\u2010side venous reimplantation onto the PTFE graft immediately proximal to the arterial heel. Because established distal AVF and vein\u2010cuff adjuncts are supported by a stronger evidence base, this configuration should be considered only as a fallback\/adaptive option in selected no\u2010vein CLTI scenarios when standard distal adjuncts are technically infeasible.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/carm\/2506957","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T08:14:11Z","timestamp":1789460051000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Controlled Heel\u2010Site Arteriovenous Vent via Venous Reimplantation on PTFE\u2010Tibial Bypass: A Novel Adjunct in No\u2010Vein Chronic Limb\u2010Threatening Ischemia"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6527-1993","authenticated-orcid":false,"given":"Francesco","family":"Spinelli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0983-7045","authenticated-orcid":false,"given":"Nunzio","family":"Montelione","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2420-5138","authenticated-orcid":false,"given":"Mario","family":"Malangone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8515-6551","authenticated-orcid":false,"given":"Vincenzo","family":"Catanese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Paolini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8259-8090","authenticated-orcid":false,"given":"Francesco","family":"Stilo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"key":"e_1_2_13_1_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2019.02.016"},{"key":"e_1_2_13_2_2","doi-asserted-by":"publisher","DOI":"10.1177\/153857440503900504"},{"key":"e_1_2_13_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.140.5.487"},{"key":"e_1_2_13_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0741-5214(96)70154-4"},{"key":"e_1_2_13_5_2","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics13071246"},{"key":"e_1_2_13_6_2","first-page":"285","article-title":"Rivascolarizzazione 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