Successful endovascular treatment of chronic total occlusion of superficial femoral artery using retrograde approach from deep femoral artery.

An 82 years-old man with intermittent claudication was admitted to our hospital. Computed tomography angiography showed his right superficial femoral artery (SFA) was chronic total occlusion (CTO), and we performed endovascular treatment (EVT). We advanced a guide-wire by contralateral transfemoral approach, but guide-wires could not penetrate the occluded SFA lesion antegradely. Thus, we tried to approach the CTO lesion retrogradely. A guide-wire passed through the collateral channel from deep femoral artery (DFA) to distal SFA. With a reverse-controlled antegrade and retrograde subintimal tracking (CART) technique, we were able to pass the CTO lesion. Finally two SMART stents were implanted. We experienced a case in which retrograde approach via collateral channel from DFA was effective to CTO of SFA.