• The pedal-plantar loop technique has been successfully applied in specialised vascular centers, showing its feasibility and safety. • However, this technique is not always feasible (15-20% of cases) due to anatomic variation of foot circulation of very challenging lesions in very tortuous arteries. • The technical key point is to advance step-by-step into thoses very narrow and tortuous arteries. • Progression with short injection througth the support catheter is mandatory. • The use of dedicated material is crucial.
