A 6Fr. sheath was inserted into the right femoral artery for ipsilateral antegrade approach. After angiography, 6Fr. sheath was exchanged into the 5Fr. Ansel guiding sheath. At the first time, we planned to cross the ATA from the retrograde direction via PTA and plantar loop. A Regalia XS 1.0/0.014 inch-300cm peripheral-guidewire was successfully cross the lesion and externalized through the plantar loop (Figure 1, Figure 2). However, balloon or even micro-catheter was failed to pass the proximal ATA, we decided to cross ATA by antegrade subintimal tracking. With the support of Finecross 1.8Fr microcatheter, the Regalia XS 1.0/0.014 inch-300cm peripheral-guidewire successfully passed the ATA and at the point of distal ATA, we made a small loop for strong push and then advanced wire to the true lumen ( Movie 5). After then, we performed the sequential balloon dilation using SLEEK 2.5x150 and Nanocross 3.0x40, several times (Figure 3, Figure 4). Final angiogram showed a successful result and good blood supply to the right foot ( Movie 6, Movie 7, Movie 8).
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