Retrograde transpedale recanalisation of tibial artery occlusion

Increasing prevalence of diabetes mellitus is frequently associated with complex tibioperoneal obstructive disease and a high rate of amputations. Endovascular therapy of arteries below the knee has emerged as a promising revascularization technique for patients with critical limb ischemia. Recent advances in catheter technology applied below the knee will increase the demand for and acceptance of minimally invasive therapy. However, when employing standard approaches, PTA of below-the-knee arteries may fail in up to 20% of cases. In the present article, we report an interventional strategy using a retrograde transpedal angioplasty approach, which was successfully applied in a 73 year old male diabetic patient with critical lower limb ischemia and a challenging occlusion of the anterior tibial and dorsalis pedis artery. This technique may probably increase success rates of PTA in cases with total occlusion of below-the-knee arteries, especially those without proximal occlusion.