The tibiopedal retrograde vascular access for challenging popliteal and below-the-knee chronic total occlusions: literature review and description of the technique.

In recent years, the retrograde tibiopedal approach is increasingly being used for revascularization of complex chronic total occlusions of infrainguinal arteries to bailout those cases where a guidewire was not possible to pass through the lesion from antegrade and therefore the treatment would have failed. The present popularity of this technique is in contrast to the paucity of data published so far. Nevertheless, from the reports that are available and from the authors' experience we conclude that it is not only a successful but also a safe technique. This article attempts to summarize the development of this technique, present the available data and to give some recommendations on how to perform a tibiopedal retrograde intervention.