Objective: The objective of the current study was to report single‑center data concerning the efficacy, safety, and midterm outcomes of
retrograde tibiopedal access, after failed antegrade attempts, for management of infrainguinal chronic total occlusions (CTOs) in patients
with chronic limb‑threatening ischemia (CLTI). Methods: This prospective, observational study was conducted between July 2016 and June
2019 and included 178 patients with infrainguinal CTO in whom a percutaneous tibiopedal access was attempted as a consequence of failed
recanalization using an antegrade approach due to ostial lesions or failed re‑entry. Results: The study reported access, crossing, and treatment
success of 93.8%, 89.9%, and 88.8% of all tibiopedal access attempts, respectively. Primary, assisted primary, and secondary patency rates
were 43.8% ± 3.9%, 64.2% ± 3.8%, and 71.7% ± 3.5% at 24 months, respectively. Kaplan–Meier analysis yielded an overall amputation‑free
survival of 71.1% ± 3.5% at 24 months. Conclusion: Retrograde tibiopedal access is an effective and safe approach as associated with high
access, crossing, treatment success, and low complication rates. This approach is considered as a bailout technique during endovascular
procedures in recanalization of infrainguinal CTOs, after failed antegrade attempts, in patients with CLTI.