A 68-years-old man addmitted to our hospital with compllaint of exertional cladicatio for a year. In his history, we recorded that he had peripheral artery isease for 5 years. Also, he had Diabetes, hypertension, and coronary artery disease. Peripheric angiography was performed and left side posterior tibial artery was found as occluded and peripheric angioplasty was planned. However, we did not detect the total lession or nipple although various angiograms were taken with different angles. So, we was to plan crossing the lession retrogradely via collateral circulation. Firstly, left side femoral artery was punctured antegradely and 6-French 55 cm long sheath was inserted to femoral artery and distal part of sheath was advanced to proximal part of popliteal artery. 0.014 inch Pilot 50 guidewire via peroneal artery was advanced to posterior tibial artery via kollateral circulation retrogradely. However, because of the chronic nature of the lession and retrograde approach we used to support catheter to cross the defect. Lession was crossed and an angiogram was took to demonstrate that the guidewire in true lumen. After crossing lesion retrogradely the nipple of total lession was seen and the lession was crossed antegradely by another guidewire. Balloon angioplasty with 2.5×80 mm balloon was performed to posterior tibial artery. Finally, angioplasty with 4.0×40 mm balloon was performed to popliteal arter and successful revascularization was suggested.
