Retrograde posterior tibial artery access for below-the-knee percutaneous revascularization by means of sheathless approach and double wire technique.

Arterial revascularization by means of percutaneous transluminal angioplasty (PTA) is a mainstay in the management of patients with peripheral artery disease and critical limb ischemia (CLI). While cross-over access from the contralateral femoral artery or antegrade access from the ipsilateral femoral artery are most commonly used when approaching subjects with CLI, PTA may occasionally fail when performed from these routes. We hereby report a patient in whom we performed retrograde arterial access through the posterior tibial artery, thus enabling recanalization of a challenging below-the-knee chronic total occlusion. Technical points pertinent to this case are clearly illustrated, including the sheathless approach and the use of a double wire strategy, one advanced ante-gradient and the other concomitantly advanced retro-gradient..