Background: patients presented mostly with critical total occlusion (CTO) in infra-genicular (IG) vessels; with medical illness recommend the endovascular approach for management. In the study, the retrograde trans-tibial approach is recommended after failure of the antegrade approach. The aim of the study was to assess the clinical outcomes of limb patency of critical limb ischemia (CLI) because of IG occlusive diseases by retrograde trans-tibial approach. Patients and methods: Through the period that started from December 2019 to October 2022. Rretrograde trans-tibial approach after failure of the antegrade approach was recommended on 26 patients complaining of CLI because of IG occlusive disease. Success of the procedure achieves by tibial revascularization and patency rate within the 12 month post intervention and record complications. Results: 26 patients were involved in the study, comprising 20 (76.9%) males and 6 (23.1%) females. Mean age ± SD was 64.4 + 14.7 years. (88.5%) were diabetic, 93.3% hypertensive, 61.5% coronary heart disease, and 69.2% were smokers. Patients with CLI were 11 (42.3%) patients attended with a severe limiting claudication, 7 (26.9%) patients were attended with ischemic rest pain and 8 (30.8%) patients were attended with minor tissue affections (tissue ulcer or toe gangrene). The primary patency was after one month was 89%, after 3 months was 85%, after 6 months 81% while after 12 months was 79%, with no significant complications. Conclusions: Retrograde tibial access revascularization of IG vessel lesion is accessible and time saving in comparison with the antegrade approach if failed with acceptable complications.