An innovative modification of the retrograde approach to angioplasty and recanalization of the superficial femoral artery.

Endovascular therapy has been performed for chronic limb ischemia since 1964, with intraluminal and subintimal angioplasty of the superficial femoral artery (SFA) gaining popularity in the last decade (1). SFA occlusions can be managed by retrograde contralateral or antegrade ipsilateral approaches (2, 3); when these approaches fail, some practitioners resort to using a re-entry device (4, 5). The retrograde popliteal approach was initially fraught with limitations and served as a backup option (1, 4, 6). However, refinements to this technique have made this an enticing option (2-7), and it has been advocated as a first-line treatment in select patients (3). We herein describe another modification of this method.