Abstract:Chronic limb-threatening ischemia (CLTI) represents the most advanced stage of peripheral artery disease, and a subset of patients are considered "no-option" because conventional surgical or endovascular revascularization is not feasible. Deep vein arterialization (DVA) has emerged as a promising limb salvage strategy by redirecting arterial blood into the distal venous system to improve tissue perfusion. With the continuous evolution of open, percutaneous, and hybrid DVA techniques, together with dedicated devices such as the LimFlow system, encouraging improvements have been achieved in technical success, limb salvage, and wound healing. This review summarizes the physiological basis, technical evolution, clinical outcomes, device development, perioperative management, and current challenges of DVA. The advantages and limitations of different techniques are also discussed to provide evidence for optimizing clinical application and future research in patients with no-option CLTI.