Combined radial-tibial access strategy and radial-tibial reverse CART in a patient with aortobifemoral graft and complex superficial femoral artery occlusion.

We present the case of a patient with a history of aortobifemoral grafting who presented with left lower extremity ischemic rest pain. Aortofemoral angiography was performed through a left radial access and showed a long, calcified total occlusion of the left superficial femoral artery (SFA) and a subtotal popliteal occlusion. The popliteal artery and SFA were crossed retrogradely through a 4-Fr anterior tibial access; the retrograde devices went subintimally and did not reenter at the common femoral level. Subsequently, the radial access was used for antegrade subintimal crossing and dilatation of the SFA, which allowed reentry of the retrograde devices (radial-tibial reverse controlled antegrade-retrograde tracking [CART]). The SFA was then successfully treated retrogradely with orbital atherectomy and drug-coated balloon angioplasty, through a 4-Fr equivalent tibial sheath. © 2017 Wiley Periodicals, Inc.