Abstract: Objective To assess the clinical efficacy of retrograde puncture subintimal angioplasty (SIA) for treatment of
occlusive diseases in the long segment of the infrapopliteal artery. Methods The clinical data of 50 patients with occlusive
diseases in the long segment of the infrapopliteal artery were retrospectively analyzed. The patients were divided into control
group (n=25) and study group (n=25) and received antegrade SIA and retrograde puncture SIA with long balloon after the
failed antegrade SIA, respectively. The ankle brachial index (ABI) and the temperature of the infrapopliteal skin before and
after the operation were compared between the two groups. Results The technical success rate was 100% in the 50 patients,
who showed obviously improved ischemic symptoms without serious complications. The ABI of the study group increased
from 0.31±0.12 before the treatment to 0.47±0.09 at 24 h, 0.56±0.06 at 1week, 0.63±0.07 at 3 months, 0.58±0.06 at 6 months, and
0.49±0.03 at 12 months after the treatment, and the skin temperature increased from 28.13±2.45 before the operation to 33.87±
1.24, 34.16 ± 0.44, 34.19 ± 0.25, 32.45 ± 0.25, and 31.05 ± 0.21 at the corresponding time points after the treatment, respectively,
showing significant improvements after the operation (P<0.05). ABI, skin temperature and the patency rate were similar
between the two groups at each of the postoperative time points (P>0.05). Conclusion Retrograde puncture SIA is safe and
effective for treatment of arteriosclerosis obliterans in the infrapopliteal arteries with a high clinical success rate and a low
complication rate after the failure of antegrade SIA.