Background: A progression of atherosclerosis leaves many patients with fewer and fewer options for revascularization until they are finally threatened by a major amputation.Objective: This review article discusses clinical decision-making and evaluates in particular the options for patient care when the arterial anatomy no longer allows a conventional surgical or interventional procedure.Material and methods: Based on an extensive literature search, scientific reports on alternative procedures for the treatment of critical limb ischemia (CLI) without possibilities for revascularization (no-option CLI) were compiled and the results on the potential for avoiding amputation were evaluated. Drug-based strategies were not considered.Results: In total, eight different strategies for avoidance of amputation could be identified and evaluated: cell therapy, gene therapy, sympathicolysis/sympathectomy, spinal cord stimulation (SCS), hyperbaric oxygenation (HBOT), hypertensive extracorporeal limb perfusion (HELP), sequential compression biomechanical device (SCBD) therapy and deep vein arterialization (DVA).Conclusion: Despite the mostly experimental character of the methods presented here, more and more instruments are becoming available to achieve limb salvage in no-option CLI patients. This review article provides an up to date overview of options for avoiding amputation by various techniques as well as the risks and results.