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Rutherford stages were III, IV, and V\/VI in 24%, 8%, and 67% of patients. Inclusion criteria were CTO at the superficial femoral (SFA), popliteal (PA), and\/or below-the-knee (BTK) level, and a failed antegrade treatment followed by a distal retrograde approach. The numbers of occluded vascular levels (OVL), lesion length, degree of calcification, technical success rate, complications, and clinical outcome were noted.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>OVL were 1 in 72%, 2 in 20%, and 3 in 8% of patients. CTOs were longer than 20\u00a0cm in 45.6% of cases and showed severe calcifications in 50.3%. Target vessels for distal access were the distal SFA\/PA in 17% and BTK in 83%. The overall technical success rate was 82%. Severe calcification decreased technical success (<jats:italic>p<\/jats:italic>\u2009=\u20090.01) despite lesion length and Rutherford stage. Clinical outcome improved in 123\/152 patients with a significant increase of the median ABI (<jats:italic>N<\/jats:italic>\u2009=\u2009158) from 0.53 (interquartile range 0.39 to 0.61) to 0.85 (0.59 to 1.03; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Complications were reported in 7.6% cases with 2.3% related to the distal vascular access.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>The tibiopedal and distal femoral retrograde access presents a safe and effective treatment option of CTOs at the thigh and\/or BTK after a failed antegrade attempt improving clinical outcome. Technical success decreased with lesion\u2019s degree of calcification.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Key Points<\/jats:title>\n                <jats:p><jats:italic>\u2022 Safety and effectiveness of the tibiopedal and distal femoral access for retrograde crossing of chronic total occlusion.<\/jats:italic><\/jats:p>\n                <jats:p><jats:italic>\u2022 Target lesion\u2019s degree of calcification decreases technical success.<\/jats:italic><\/jats:p>\n                <jats:p><jats:italic>\u2022 Complications related to the distal vascular access were rare.<\/jats:italic><\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00330-020-07082-3","type":"journal-article","created":{"date-parts":[[2020,7,28]],"date-time":"2020-07-28T17:26:17Z","timestamp":1595957177000},"page":"535-542","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Tibiopedal and distal femoral retrograde vascular access for challenging chronic total occlusions: predictors for technical success, and complication rates in a large single-center cohort"],"prefix":"10.1007","volume":"31","author":[{"given":"Gerd","family":"Gr\u00f6zinger","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Hallecker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrich","family":"Grosse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland","family":"Syha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominik","family":"Ketelsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus","family":"Brechtel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Lescan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantin","family":"Nikolaou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Artzner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,7,28]]},"reference":[{"key":"7082_CR1","doi-asserted-by":"publisher","first-page":"1901","DOI":"10.1016\/j.jacc.2016.02.040","volume":"67","author":"S Agarwal","year":"2016","unstructured":"Agarwal S, Sud K, Shishehbor MH (2016) Nationwide trends of hospital admission and outcomes among critical limb ischemia patients: from 2003\u20132011. 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There is no conflict of interest.The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"One of the authors has significant statistical expertise and no complex statistical methods were necessary for this paper.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"Written informed consent was waived by the Institutional Review Board.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"Institutional Review Board approval was obtained.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"One of the subjects or cohorts have been previously reported.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"value":"\u2022 retrospective\u2022 observational\u2022 performed at one institution","order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}