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Critical limb-threatening ischaemia (CLTI) represents a significant source of morbidity and mortality. With advanced disease, occlusion of the pedal arteries commonly used for angioplasty or distal bypass often leads to failure of all conventional revascularization attempts and leaves major amputation as the last treatment option (Fig. 1a, b). In such cases of no-option CLTI, salvage modalities using lumbar sympathectomy, prostanoids, stem cells therapies and spinal cord stimulation have been used to varying efficacy. 1–4 Deep venous arterialization (DVA) represents another viable option that involves arterialization of the disease-free venous beds