80 year old female patient with past medical history of hypertension, dyslipidemia, diabetes mellitus type II, 40 pack year smoking history presents with complaints of bilateral claudication in calf with right left leg (Rutherford class I category 3). Patient had ABI/PVR which showed 0.7 on the right and 0.82 on the left with waveforms suggestive of femeropopliteal disease. Peripheral angiogram performed showed chronic total occlusion (CTO) of the ostial right superficial femoral artery (SFA), CTO of the right anterior tibial and posterior tibial artery. Boderline stenosis of the left common iliac artery, significant stenosis of the left superficial femoral artery, left peroneal artery and CTO of the left anterior tibial noted. Patient currently planned for an endovascular intervention of the CTO of ostial right SFA via retrograde approach. We will discuss about the endovascular indications, approach towards complex SFA CTO via retrograde approach.
