Simplified Endovascular Deep Venous Arterialization for Non-option CLI Patients by Percutaneous Direct Needle Puncture of Tibial Artery and Vein Under Ultrasound Guidance (AV Spear Technique). The following case report describes the AV spear technique for percutaneous deep venous arterialization. 
AV spear technique
After an ultrasound survey was performed to find the puncture point adjacent to the ankle joint where the posterior tibial vein (PTV) runs superficially to the posterior tibial artery (PTA), percutaneous penetration of the PTV and PTA was conducted. 
ultrasound survey
Then a microguidewire was inserted from the distal puncture site into the PTA and advanced into the arterial sheath, establishing a through-and-through wire. 
microguidewire
A microcatheter was then advanced antegradely over the through-and-through wire. 
microcatheter
After removing the wire, a hydrophilic guidewire was utilized in order to identify the venous lumen. 
hydrophilic guidewire