Distal retrograde access: Step by step

Complex long lesions are now in the endovascular realm, but with a rate of failure of 10-20% due to impossibility of crossing the lesion. Several CTO devices were developed by commercial companies but are expensive. Distal retrograde access is now the first choice approach in such scenario, improving procedure success, recanalization rate and limb salvage rate, being fast cheap and feasible in the majority of the cases, with low complication rates. The step by step is described.