Retrograde Angioplasty: A Simple Bailout Technique for Failed Antegrade Crossing of Femoropopliteal and Tibial Lesions

doi:10.21608/ejhm.2025.411584

Retrograde Angioplasty: A Simple Bailout Technique for Failed Antegrade Crossing of Femoropopliteal and Tibial Lesions

Document Type : Original Article

10.21608/ejhm.2025.411584

Abstract

Background: Endovascular revascularization is the preferred treatment for chronic limb-threatening ischemia (CLTI). However, standard antegrade approaches often fail in complex infragenicular occlusions. Retrograde tibial artery access has emerged as a viable alternative, offering improved technical success rates and procedural feasibility.
Objective: This study aimed to evaluate the feasibility, safety, and early outcomes of retrograde ankle tibial artery access in patients with below-the-knee CLTI who failed conventional antegrade recanalization.
Patients and methods: This prospective study included 19 patients (and 68% were males) with a mean age of 71.3 ± 11.8 years with Rutherford class 4–5 CLTI who underwent endovascular recanalization via retrograde tibial access after failed antegrade attempts. Technical success, procedural complications, and six-month outcomes, including patency and limb salvage, were assessed.
Results: Retrograde tibial access was successfully established in 18 patients (95%), with lesion crossing and revascularization achieved in 16 (84%). The six-month primary and secondary patency rates were 68% and 89%, respectively. Amputation-free survival at six months was 79%, with major amputations required in three cases (16%). Retrograde access-related complications occurred in four patients (21%) but were minor and managed conservatively. No procedure-related mortality was reported.
Conclusion: Retrograde tibial artery access is a safe and effective bailout strategy for failed antegrade revascularization in CLTI patients, demonstrating high technical success and acceptable long-term patency. This approach may serve as a valuable alternative to more complex techniques in challenging infragenicular occlusions.

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