Retrograde salvage approach to treat tibial artery perforation during attempted revascularization of a chronically occluded artery

Arterial perforation is a well‐recognized complication of attempted percutaneous revascularization of a chronic totally occluded tibial artery and typically necessitates termination of the procedure. This report describes a step‐by‐step approach on how to perform a direct posterior tibial artery puncture and a sheathless wire introduction, to salvage a case of tibial artery perforation induced during attempted anterograde recanalization of an occluded tibial artery. After control of blood loss, retrograde wire passage and balloon inflation can facilitate relocation of the anterograde wire in the true lumen allowing uneventful completion of the procedure. © 2010 Wiley‐Liss, Inc.