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Critical Limb Ischaemia (CLI) is the clinical end stage of Peripheral Artery Disease (PAD) associated with a high risk of major amputation, cardiovascular events, poor quality of life and death. Bypass surgery and/or endovascular interventions are the first-line treatment of choice in these cases to prevent amputation and resolve rest pain. Other treatment methods are either in the study phase (gene and stem cell therapy) or have little or no effect (vasoactive therapy or spinal cord stimulation). Unfortunately, about 15%-20% of CLI patients are not candidates for distal revascularization because of a lack of target outflow vessels. Surgical Deep Venous Arterialization (DVA) provides reverse flow to the capillary beds and increases collaterals. DVA may be considered as a viable alternative before major amputation in patients with CLI due to an unreconstructable lower extremity arterial disease.