Endovascular retrograde tibial access for limb salvage in Chronic Limb-Threatening Ischemia: A Case Report

Abstract Background: Peripheral artery disease is a chronic disorder characterised by stenosis and/or occlusion of peripheral large and medium-sized arteries. It most commonly affects the lower limbs, causing claudication, and foot ulcers/gangrene, which if not treated correctly can lead to Chronic Limb-Threatening Ischemia. This condition requires revascularization to improve limb perfusion and limit the risk of amputation. Case presentation: We describe the case of a 76-year-old Latin American male who presented to the emergency department with ischemic rest pain and ulceration of the left limb. Angiotomography showed severe stenosis in the left common femoral, superficial femoral, and popliteal left arteries. Percutaneous angioplasty intervention was made to restore the blood flow and limb salvage. A retrograde approach was obtained via ultrasonography-guided tibial anterior artery puncture. The post-procedural course was uneventful. The retrograde puncture technique allowed adequate blood flow without complications. Follow-up 2 months later showed resolution of foot ulcer. Conclusions: There are still limited studies available to evaluate the effectiveness and long-term success of tibio-pedal access for revascularization, nevertheless, it shows a promising option for patients with poor surgical options in need of urgent intervention.