The left foot was prepped and draped in usual sterile manner. Using ultrasound-guided access to obtain access in the left dorsalis pedis artery, I was able to navigate a wire to the distal leg where there was a known CTO. I was able to place a 4-French sheath. I administered heparin and performed angiography, which revealed that there was a chronic total occlusion cap shortly after the sheath. Again, the sheath was not even inserted fully, the length, there was some sheath hanging out from the skin. It was noted, however, that the systolic blood pressure was over 80 mmHg. Patient also had significant collateralization seen from the peroneal and supplied the remainder of the foot. We then attempted to navigate through the CTO with a Treasure 12 and a microcatheter and navigated through, we did remain intraluminal but when I placed the catheter up towards the more proximal leg and performed angiography, this revealed I was in the venous system. I therefore retracted the catheter and the wire backwards at the level of the CTO. There must have been an AV fistula formed. I therefore continue to retract to navigate through. At times I was in the subintimal space and at times I was in another venous space. After multiple attempts and about 40 mL of contrast used I aborted the procedure. There is no balloon angioplasty performed, just wiring. At the end of the procedure., rpeat angiography showed no evidence of perforation, dissection or embolization and patient remained with a blood pressure systolic of 80s in the DP pedal access area.