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This study aims to assess the feasibility, safety, and efficacy in terms of acute outcome of the endovascular retrograde crossing of femoro\u2010popliteal occlusions with tibial access.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study is a single\u2010centre, retrospective analysis of prospectively collected data of 152 consecutive patients, who had undergone, from September 2015 to September 2022, endovascular treatment of femoro\u2010popliteal arterial occlusions with retrograde tibial access after the failure of the antegrade approach.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The median lesion length was 25\u2009cm and 66 patients (43.4%) had a calcium grading according to the peripheral arterial calcium scoring system of 4. Angiographically, 44.7% of the lesions were TASC II category D. In all cases, successful cannulation and sheath introduction were performed with an average cannulation time of 150.4\u2009s. Femoropopliteal occlusions were successfully crossed with the retrograde route in 94.1% of cases; the intimal approach was performed in 114 patients (79.7%). The mean time from puncture to retrograde crossing was 20.5\u2009min. Acute vascular access\u2010site complications were noted in 7 (4.6%) patients. Thirty\u2010day major adverse cardiovascular events rate and 30\u2010day major adverse limb events rate of 3.3% and 2%, respectively, were observed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The results of our study indicate that retrograde crossing of femoro\u2010popliteal occlusions with tibial access is a feasible, effective, and safe approach in case of failed antegrade approach. The results presented represent one of the largest investigations ever published on tibial retrograde access and contribute to the small body of literature present on this topic to date.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ccd.30654","type":"journal-article","created":{"date-parts":[[2023,4,19]],"date-time":"2023-04-19T10:31:13Z","timestamp":1681900273000},"page":"1108-1119","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Endovascular treatment of femoro\u2010popliteal occlusions with retrograde tibial access after failure of the antegrade approach"],"prefix":"10.1002","volume":"101","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7680-0851","authenticated-orcid":false,"given":"Roberto","family":"Minici","sequence":"first","affiliation":[{"name":"Radiology Unit, Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro University Hospital Mater Domini Catanzaro 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