Endovascular treatment for chronic total occlusion of superficial femoral artery: Is retrograde approach from popliteal artery effective and safe?

A 55-year-old male was admitted with numbness in the left foot and intermittent claudication. Doppler ultrasound and digital subtraction angiography presented chronic total occlusion in the ostial of left superficial femoral artery and reperfusion flow at one-third below from collateral channels of deep femoral artery. Thus, we decided to perform an endovascular intervention for this patient. First, we used contralateral transfemoral approach technique, but the microwire could not reach to the occluded superficial femoral artery lesion. Then, we approached the chronic total occlusion lesion retrogradely. A wire was passed successfully from the popliteal artery to ostial superficial femoral artery. Finally, 2 stents were implanted. This case highlights that popliteal retrograde approach is effective and safe for total occlusion of superficial femoral artery.