Management of femoral-popliteal arterial occlusive disease using percutaneous treatment with a stent graft is comparable with surgical revascularization with conventional femoral-to-AK popliteal artery bypass using synthetic material up to 12 months. Longer-term follow-up would be helpful in determining ongoing efficacy.

Aberrant right subclavian artery aneurysms are rare but demonstrate a propensity toward rupture; thus, early elective repair is mandated. Novel endovascular modalities are available to offer less-invasive treatment for a patient population with increasing comorbidities. We report a case of a 65-year-old woman with an aberrant right subclavian artery aneurysm causing dysphagia lusoria. The aneurysm was excluded proximally at Kommerell's diverticulum with a Zenith iliac plug and excluded distally by surgical ligation combined with a right carotid-subclavian artery bypass to preserve extremity perfusion.

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Arterioenteric fistulae often present a diagnostic and therapeutic dilemma for physicians. Traditional therapy consists of open repair, which is often poorly tolerated by patients. As a consequence, endovascular repair, consisting primarily of stent graft exclusion, has been attempted by some as a less invasive approach. We report a patient with an ilioenteric fistula in which hemorrhage was successfully treated with an Amplatzer Vascular Plug (AGA Medical Corporation, Plymouth, Minn).

antegrade approach. Routine anticoagulation and dual-antiplatelet therapy was used peri-procedurally. Antegrade access was used to treat any lesion that required a stent placement, after the retrograde wire was snared and brought through the antegrade guide catheter. Patient indications and comorbidities were recorded; outcomes analyzed were limb salvage rate, peri-procedural complications and mortality. Mean and standard deviations were calculated; Kaplan-Meier was used to calculate limb salvage rates. Results: A review all lower extremity interventional angiograms from July 2010 thru August 2013 (n ¼ 764) identified 13 cases in which a retrograde pedal access was performed (mean age was 71.4 6 12.4 years, 9 men). There was high prevalence of diabetes (77%; 10/13), chronic renal insufficiency (stages III-V; 69%, 9/13), and previous contralateral major amputation (38%; 5/13). Indications for a retrograde pedal revascularization were Rutherford chronic limb ischemia class IV (15%; 2/13) and class V (85%; 11/13). Technical success rate was 69% (9/13); a variety of popliteal (2/13) and tibial (13/13) vessels were intervened with angioplasty alone (10/13) via a retrograde approach and with angioplasty/stent placement (3/13). The technical failures were due to inability to cross the occlusion(s). Periprocedurally, there was one myocardial infarction, no local complications, worsening renal insufficiency or deaths. At a mean follow-up of 13.4 6 10.3 months, the limb salvage rate was 77% (10/13) (Fig). There was a high mortality rate on follow-up in this cohort (23%; 3/13) occurring at median 6 6 4 months. Conclusions: Retrograde pedal access for limb salvage in high-risk patients is feasible and safe with acceptable limb salvage rates at intermediate follow-up. Appropriate candidates are those who have failed an antegrade intervention and are poor candidates for a tibial bypass. Future studies should test whether this mode of revascularization has favorable limb salvage rates in larger patient populations.