الفهرس 
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Abstract
Peripheral arterial disease (PAD) is a worldwide problem that has the potential to cause loss of limb or even loss of life. The prevalence of this vascular global problem in the general population is increased nowadays with increasing of prevalence of its risk factors as diabetes mellitus, hypertension, smoking, hyperlipidemia and others.
Critical limb ischemia (CLI) is the form of PAD in which severe arterial perfusion insufficiency leading to a threatened limb condition. Usually the patient will be presented by ischemic rest pain or presence of tissue loss in the form of ulcer or gangrene.
Endovascular treatment is the preferred modality of revascularization in patients with critical limb ischemia as many of them carry high risk to undergo open surgical procedures because of the associated comorbidities.
The access of the endovascular treatment is usually obtained through the common femoral artery whatever ipsilateral or contralateral. In certain conditions when the common femoral artery access is not suitable, alternatively, a retrograde
Summary
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ipsilateral approach can be used through one of the arteries distal to the lesion.
In this study, we worked on patients who failed to be revascularized antegrade. Variant of accesses was created; popliteal, anterior tibial and posterior tibial. Ultrasound-guided puncture was needed in some of these cases.
Technically, a high success rates was achieved when the retrograde approach was used, as the puncture was done and the lesion was crossed and treated adequately through a retrograde access in most of cases.
At the end of the 6-month period of follow up, the mean of ABI showed statistically significant rising, that means the procedure had a satisfactory outcome in short-term follow up period.
All patients were showed a significant dramatic relieve of previously presented rest pain post-intervention and during the period of follow up. Others who were presented with foot ulcers show significant improvement up to complete healing at the end of the six-month. One patient died two months post intervention, and another failed to stick to the follow up