When the standard endovascular crossing maneuvers have failed during CLTI recanalization procedures and the distal below-the-knee or proximal below-the-ankle retrograde access is not possible due to chronic occlusion of the vessels, mastering the more distal and complex retrograde BTA punctures may be advantageous.There are scanty reports regarding the retrograde puncture of the mid and forefoot vessels. The aim of this article is to review different tips and tricks related to these techniques to help operators to apply them in specific scenarios to eventually improve procedural success rate.
Keywords: balloon angioplasty; below-the-ankle; below-the-knee; chronic total occlusion; critical limb ischemia; limb salvage; pedal artery; plantar artery; recanalization; retrograde approach.