الفهرس 
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Abstract
SUMMRY
Critical limb ischemia (CLI) occurs as an arterial stenosis approaches a critical point, patients present with rest pain and/or non healing ulceration (1% to 2% of PAD). Nearly 40% of patients with CLI require amputation.
Arterial revascularization through endovascular treatment is a common procedure for patients with occlusive diseases. Percutaneous recanalization of the affected artery is the most important alternative to surgery.
In 1990, Iyer and colleagues described the use of a retrograde pedal/tibial approach to handle cases in which the conventional way of crossing the tibial lesion had failed.
This is a prospective study including 50 patients presented to the vascular unit of Beni-Suef University Hospital (January 2015 to December 2017) with infra popliteal arterial occlusive disease (25 patients with failed antegrade femoral angioplasty 50% -15 patients suffered from rest pain 30%-10 patients suffered from tissue loss 20%).
After the procedure, all limbs had at least one patent tibial artery; either anterior tibial artery or posterior tibial artery with good distal-run off to the pedal vessels.
Technical success rate; -66 % to achieve at least one patent tibial feeding vessel for every treated limb -34% the failure to achieve patency of affected vessels beside failure to gain the access site.
Follow Up; -After one month, primary patency rate was 100% and limb salvage rate was 100%-After 6 months follow up, Primary patency rate was 90% by duplex scan. While, limb salvage rate was 100% in 6 months follow up. There was no need for re-angioplasty.
Retrograde Trans-pedal interventions represent a unique and potentially limb preserving recanalization and revascularization technique in patients with CLI and advanced tibial occlusive disease.
Although retrograde pedal/tibial artery access is a relatively new technique, it is a promising alternative for patients in whom conventional endovascular techniques failed to achieve recanalization of the tibial vessels.