Abstract

A 60-year-old man was urgently hospitalized in the vascular surgery department due to critical ischemia and incipient gangrene in his left leg. A computed tomography angiography (CTA) revealed occlusion of the distal portion of the left superficial femoral artery and popliteal artery, with an occluded previous bypass of the left popliteal artery. Revascularization angioplasty was initiated using an antegrade approach. While the antegrade approach is a common method for revascularization, it is not always successful, leading to a significant increase in the risk of amputation due to continued ischemia in the leg. Following the unsuccessful antegrade approach, the technique of distal retrograde puncture was introduced, which could be used as an alternative method in complex cases to improve the success of revascularization. Bypass surgery was no longer an option without additional risks, and the recommended endovascular approach according to treatment guidelines failed. Therefore, employing the retrograde technique potentially saved the patient from lower limb amputation. This patient group poses challenges, and the procedure is technically complex, requiring a multidisciplinary team and specialized equipment.