Background:  Critical limb ischemia occurs when the blood flow to the leg is insufficient to maintain the metabolic requirement of the tissue in the resting state. Objectives: This study was to describe the technical aspects of the retrograde approach as an alternative for failed antegrade access for difficult below the knee chronic total occlusions. Patients & Methods: This study was conducted as retrospective and prospective interventional study that included 18 patient with CLI of deferent ages and sex who were admitted to the department of vascular surgery at Zagzaig university Hospitals. Results: we can deduce the major predictive values of technical and clinical success related to endovascular intervention which were lesion characteristics represented in its length and nature, picture of presentation and co-morbid conditions. Conclusions: Retrograde tibiopedal approach can be used safely as a bailout to increase the technical success rate and limb salvage for failed antegrade recanalization of popliteal and infrapopliteal arterial occlusions.