Abstract
Flush occlusion of the superficial femoral artery (SFA) poses significant challenges for endovascular revascularization because the absence of a distal stump complicates antegrade access. Traditional treatment options include balloon-directed catheter thrombectomy, mechanical thrombectomy, and tissue plasminogen activator thrombolysis. However, these approaches may be less effective in cases of flush or long-segment occlusions. The retrograde popliteal approach has emerged as a viable alternative, providing direct access to the distal true lumen and proving particularly useful when antegrade strategies fail. This case report describes the successful use of the retrograde popliteal approach to treat a flush SFA occlusion caused by arterial thrombosis, highlighting its role in managing complex peripheral arterial disease.