Retrograde Tibiopedal Access for the Treatment of Critical Limb Ischemia

Critical limb ischemia (CLI) is associated with high rates of morbidity and mortality. Many patients with CLI are poor surgical candidates. Endovascular therapy has been shown to be an effective technique to improve arterial perfusion for patients with CLI. In patients with isolated infrapopliteal occlusive disease, endovascular therapy may be more effective than conventional bypass surgery. When antegrade endovascular revascularization fails, an understanding of tibiopedal access and retrograde crossing techniques is essential to re-establish flow to aid in tissue healing, provide symptomatic relief, and avoid amputation.