Novel retrograde puncture technique for infrapopliteal artery revascularization: transplantar retrograde access

Patients with critical limbs ischemia received endovascular revascularization for his posterior tibial artery (PTA) to plantar artery long occlusion without proximal stump. Antegrade recanalization seemed impossible, so retrograde access should be considered. However, the conventional retrograde puncture was also not available. Therefore, novel retrograde transplantar access was conducted. The plantar artery was successfully punctured with a 20-G needle. In addition, a guidewire was retrogradely inserted with a sheathless technique. Finally, it was retrogradely crossed the occluded lesion. The final angiogram showed sufficient results. Transplantar retrograde access was feasible technique for infrapopliteal EVT, when the conventional antegrade and retrograde approaches were not available.