Up to 20% of patients with Critical Limb Ischemia (CLI) are not considered good candidates for endovascular revascularization. If recanalization of a chronic occlusion of a BTK/ BTA artery proves to be impossible owing to the inability to cross an extensive occlusion or in the presence of a “desert foot”, percutaneous venous arterialization has proven to be a bailout strategy for limb salvage. Drs. August Ysa and Marta Lobato, from Vascular Surgery Dpt. Hospital de Cruces, Barakaldo (Spain), present the last update in Percutaneous Venous Arterialization technique and expose a Case in the box.