The authors report on a diabetic patient with tissue loss, previously treated with a femoral-tibial bypass, which occluded shortly after construction. A combination of antegrade contralateral femoral and retrograde tibial access was used for revascularization. Angiogram demonstrated a dissection flap occluding the deep femoral artery flow, which was unable to be crossed from an antegrade approach. A retrograde deep femoral artery access was used to perform “kissing” angioplasty of the origins of the superficial and deep femoral arteries, thus successfully reestablishing flow to both vessels. This represents an unconventional endovascular technique that can be safely performed as a bailout maneuver.
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