Techniques and outcome of retrograde crural artery revascularization

In complex popliteal to infrapopliteal occlusions, an endovascular recanalization attempt can fail in a substantial number of cases. The additional use of a retrograde approach seems feasible and safe and can favorably modify this failure rate. However, this is a technique that requires training and is associated with a learning curve. Although this technique is widely practiced among experienced endovascular specialists, the literature contains reports of less than 100 of these cases. We present our experience with the retrograde approach for the treatment of complex tibial arterial disease. Insights into the technical aspects of the procedure and optimal case selection are discussed.