Crossing techniques and devices in femoropopliteal chronic total occlusion intervention

Chronic total occlusions (CTO) are common in patients with symptomatic peripheral arterial disease. Endovascular CTO intervention remains a challenging endeavor for interventionalists, but is being increasingly considered as a plausible alternative to surgical revascularization, even for complex CTO lesions. We review common endovascular techniques using antegrade, retrograde and transcollateral approaches in femoropopliteal CTO intervention. In addition, we review the current literature on the utility, efficacy, and safety of novel crossing and re-entry devices in femoropopliteal CTO interventions.