Percutaneous approach to deep vein arterialization for the “no-option” chronic limb-threatening ischemia patient

Chronic limb-threatening ischemia is an advanced stage of peripheral artery disease characterized by rest pain or tissue loss. Treatment of patients classified as ``no-option'' CLTI remains particularly challenging, as historically their primary treatment has been limited to major amputation. Venous arterialization has emerged as a promising alternative in this difficult-to-treat population. Advances in optimized technology and endovascular techniques, particularly deep venous arterialization, have had encouraging outcomes for long-term limb salvage. Successful limb preservation relies on proper patient selection, a compliant patient, and a robust multidisciplinary clinical team to support the complex processes of deep venous arterialization maturation and wound healing. This review will discuss the historical background of venous arterialization, patient selection criteria, and surgical techniques for percutaneous deep venous arterialization, and postoperative management after the index procedure, including wound care, surveillance, and reintervention strategies for successful limb salvage.