Patients with no-option chronic limb-threatening ischemia are not candidates for conventional revascularization options and will inevitably require major amputation. Deep venous arterialization (DVA) is a potential option for these patients. A complete endovascular system to perform DVA has recently received great acclaim and US Foor and Drug Administration approval. https://www.diegojavierfares.com/mega-pick-SA439-EF75-5-x-7-Embroidery-Machine-Hoop-mega-pick/