ALT Figure 1. Key Procedural Steps for Transcatheter Arterialization of the Deep Veins. The steps for transcatheter arterialization of the deep veins in the lower leg involve obtaining ultrasound-guided pedal vascular access (Panel A); advancing the needle into the mesh cage for establishment of arteriovenous crossing (the needle is in the arterial system and advances through the artery into the vein; the basket is in the vein) (Panel B); rendering venous valves incompetent with a push valvulotome (Panel C); deploying a straight covered stent at the level of the calcaneus (Panel D); and lining the vein with straight stents before placing a tapered, self-expanding, covered stent across the arteriovenous crossing to establish arterial blood flow in the venous system (Panel E).