Persisting Rest Pain and Claudication of a Critical Limb Ischemia Patient After Performing a Superficial Femoral Artery Antegrade Approach Procedure

Case Summary. A popliteal artery entrapment syndrome and subsequent bypass surgery could cause severe, hard, fibrous occlusion of the native popliteal artery. Endovascular therapy that opens the native vessel is important to keep patency. It was impossible to advance the antegrade wire, as the entry of the native artery was not found by angiography or intravascular ultrasound imaging, making retrograde approach mandatory in our case. However, retrograde angiography also indicated that there was no entry point. Therefore, we firstly opened the bypass graft to monitor the distal anastomosis site, and to guarantee that there would be straight flow in the event that the native vessel could not be opened.