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Recanalization in an antegrade fashion in complex infrainguinal arterial disease can prove challenging and use of the Outback re-entry device via a retrograde approach may be an option.    Case presentation  Using an antegrade approach we were unable to cross the native occluded superficial femoral artery in a patient after two occluded bypasses, with ulcers and was unfit for general anaesthesia.  We successfully attempted retrograde re-entry using an Outback device via a phantom segment of the anterior tibial artery. After angioplasty and stenting a satisfactory result was achieved with one artery runoff.    Conclusions  At the 24 months follow up reconstruction was patent and ulcers were healed after 4 months.  The outcome of more cases will be decisive for the broader applicability of this technique.

Retrograde insertion of the outback reentry device from a tibial artery for complex infrainguinal recanalization