On this week’s episode of the Life of Flow Podcast, we sit down with Daniel A.F. van den Heuvel, MD, live from Chicago at the Amputation Prevention Series, to explore the evolving role of Deep Venous Arterialization (DVA) in the fight against CLTI.
From the very first cases to today’s next-gen technology, Dr. van den Heuvel shares what Europe has learned in the absence of the LimFlow kit, how physicians adapted with off-the-shelf techniques, and what renewed availability and access to LimFlow in Europe means for patients who were once considered “no-option.”
🎧 For specialists, this episode is a masterclass in both the art and science of limb salvage, shedding light on what still fails, what works, and what’s coming next for global CLTI management.
05:04 How foot X-rays reveal more about limb loss risk than angiograms
07:13 Why medial artery calcification is now seen as a major amputation predictor
10:12 Should DVA remain for “no-option” patients or be used earlier?
14:34 The ischemic hit dilemma and the need for predictive models
16:07 Balancing flow to avoid the “DVA storm” and catastrophic ischemia
20:15 Why post-DVA pain should never be considered “normal”
26:46 Shifting patient consent: from toe loss expectations to toe preservation
27:50 Do DVAs really work? Biological change and wound healing after occlusion
35:30 Europe’s “DIY era” and what the LimFlow relaunch means for access
48:17 The future of DVA: earlier adoption, better tools, and deeper biology
💡 Who Should Listen
This episode is for vascular surgeons, interventional radiologists, podiatrists, wound-care specialists, and all clinicians managing patients with chronic limb-threatening ischemia (CLTI). It’s also relevant for industry leaders, researchers, and healthcare professionals interested in how innovations like Deep Venous Arterialization (DVA) and LimFlow’s relaunch in Europe are reshaping global limb salvage.
About Daniel A.F. van den Heuvel, MD
Daniel A.F. van den Heuvel, MD, is an interventional radiologist at St. Antonius Hospital in the Netherlands, where he specializes in advanced vascular interventions with a focus on chronic limb-threatening ischemia (CLTI) and pulmonary artery vascular disease. After completing medical school at the University of Amsterdam, he chose interventional radiology over surgery, drawn by its potential to combine hands-on skill with patient-centered care. Since finishing his fellowship in 2011, he has built extensive expertise in endovascular revascularization and transcatheter arterialization of the deep veins (TADV/DVA).
As Program Director of the IR residency at St. Antonius, Dr. van den Heuvel also trains the next generation of interventional radiologists, emphasizing not only technical mastery but also the soft skills required to care for patients in multidisciplinary teams.
His current work explores unmet needs in CLTI, from improving long-term patency of below-the-ankle interventions to advancing the role of DVA in “no-option” patients. Beyond limb salvage, he maintains a special research interest in pulmonary arteriovenous malformations (PAVM) and balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension (CTEPH).
Connect with Daniel A.F. van den Heuvel, MD
💼 LinkedIn: Daniel van den Heuvel
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