To investigate the clinical effect and application value of ultrasound-guided subintimal angioplasty with antegrade-retrograde intervention in the arteries below-the-knee of patients with arteriosclerosis obliterans (ASO).

Between January 2012 and December 2016, 15 ASO patients who underwent subintimal angioplasty with antegrade-retrograde intervention guided by ultrasound in the arteries below-the-knee in the First People's Hospital of Nantong were selected for this study. Under the guidance of ultrasound, a micro-needle was punctured into the target vessel, introducing the micro wire, micro sheath, guidewire and sheath in turns. Upon confirmation by angiography, the guidewire was pushed upstream repeatedly and crossed the occlusion gradually. When it kissed with the downward sheath, the subintimal angioplasty was then performed.

Retrograde punctures in 15 cases were technically successful with no occurrence of serious complications and the subintimal angioplasties with antegrade-retrograde intervention all succeeded. The total operation time of the 15 cases averaged 45-180 min, of which 5 min (2-15 min) for ultrasound-guided procedures. The average amount of intra-operative blood loss was 20 ml.

Ultrasound-guided retrograde puncture is a safe, convenient and reliable approach that is worth of clinical application, because it not only reduces the operation time but also improves the success rate of SIA.