A stepwise approach in endovascular treatment for stumpless anterior tibial artery occlusion

Endovascular treatment of infrapopliteal lesions is challenging. An antegrade approach to the origin of the anterior tibial artery (ATA), which branches sharply from the relatively large popliteal artery with a preserved lumen, can be more challenging than initially expected. Moreover, in cases with ambiguous entry points of the occluded ATA, establishing retrograde access is promising for successful intervention. We present a case of chronic limb-threatening ischemia with an unidentified entry point for ATA occlusion in which stepwise modification of the endovascular treatment strategy was a critical determinant of successful revascularization.