Controlled antegrade and retrograde subintimal tracking technique for endovascular treatment of the superficial femoral artery with chronic total occlusion.

Although providing endovascular treatment for chronic total occlusion (CTO) in patients with peripheral arterial disease is challenging, subintimal angioplasty (SIA) has proven to be an effective procedure. However, the SIA device may not cross CTO lesions because of the inability to achieve re-entry into the distal true lumen in some cases. We herein describe 2 cases of CTO of the superficial femoral artery (SFA) segment in which we failed to cross the site of CTO using the SIA technique and therefore employed the controlled antegrade and retrograde subintimal tracking (CART) technique to successfully treat the CTO lesions of SFA. When using the CART technique, there is no need to perform extension of the region of subintimal dissection beyond the occluded lesion, which may be useful for managing CTO lesions.