Retrograde insertion of the outback reentry device from a tibial artery for complex infrainguinal recanalization

INTRODUCTION: Recanalization in an antegrade fashion in complex infrainguinal arterial disease can prove challenging and use of the Outback re-entry device via a retrograde approach may be an option. CASE PRESENTATION: Using an antegrade approach we were unable to cross the native occluded superficial femoral artery in a patient after two occluded bypasses, with ulcers and was unfit for general anaesthesia. We successfully attempted retrograde re-entry using an Outback device via a phantom segment of the anterior tibial artery. After angioplasty and stenting a satisfactory result was achieved with one artery runoff. CONCLUSIONS: At the 24 months follow up reconstruction was patent and ulcers were healed after 4 months. The outcome of more cases will be decisive for the broader applicability of this technique.