Transcollateral approach for percutaneous revascularization of complex superficial femoral artery chronic total occlusion.

Chronic total occlusions of the superficial femoral artery occur in approximately 40% of patients with symptomatic peripheral arterial disease. When antegrade revascularization fails or is not feasible, a retrograde approach should be considered. This is usually via the popliteal or tibial vessels. Alternatively, transcollateral revascularization has been reported. This report describes the use of transcollateral retrograde revascularization of the superficial femoral artery in two patients with failed antegrade crossing. Retrograde recanalization was achieved via a branch of the profunda femoris artery. Unlike previous reports that describe retrograde crossing and subsequent snaring of the wire, these cases were performed with retrograde passage of a low-profile balloon. Following retrograde balloon dilation, the vessel was rewired from an antegrade approach and the procedure was completed with complications.