Purpose of Review <p>To review the updated literature of transcatheter arterialization of deep veins (TADV). TADV is a novel limb salvage procedure that is utilized in patients who have exhausted conventional options of bypass surgery or endovascular recanalization of native arteries and are at risk of lower extremity amputation.</p> Recent Findings <p>In a multicenter prospective study, TADV continues to demonstrate significant limb salvage of 68.7% at one year for patients that would otherwise be considered “no option”. In comparison, “no option” patients that did not undergo TADV had a 45% major amputation rate at one year. Dialysis dependent patients continue to demonstrate poor outcomes with elevated rates of amputation and increased mortality at one year.</p> Summary <p>Although standard of care for chronic limb threatening ischemia is optimal medical therapy and revascularization of the distal extremity, up to 20% of these patients do not have appropriate anatomy to undergo revascularization and are deemed “no option”. For these “no option” patients, TADV has proven to be a novel option for limb salvage and wound healing.</p>