Road Mapping Guided Puncture Versus Ultrasound Guided Puncture During Retrograde Angioplasty Feasibility and Safety

Inclusion criteria: -. 1. Adults : Both male and female participants. 2. Diagnosed with critical limp threatening ischemia (CLTI): significant occlusions in the femoropopliteal o Rutherford Class 5: Non-healing wounds or ulcers 3. Failed or unable to achieve antegrade access: Patients requiring retrograde puncture for the procedure. 4. Planned intervention with retrograde access: Candidates for endovascular interventions, including angioplasty, stent deployment Exclusion criteria: • Active infection at the puncture site: Any localized infection, particularly over the ankle region , will be an exclusion. • Severe calcification or anatomical abnormalities: Patients with excessive arterial calcification or significant anatomical distortion preventing safe retrograde puncture.