PATIENT: 57-year-old female with severe short-distance claudication.

PROCEDURE: Endovascular recanalisation under local anaesthesia and conscious sedation via left brachial (4 Fr) and bilateral femoral (6 Fr) access.

FINDINGS: Critical left subclavian stenosis (pre-dilated). Complete occlusion of distal abdominal aorta and bilateral common iliac arteries.

TECHNIQUE:
1. Left: antegrade subintimal recanalisation with spontaneous re-entry.
2. Right: combined antegrade/retrograde subintimal approach with BeBack re-entry device.

TREATMENT: Kissing 8 mm covered stent grafts (Bentley BeGraft) at aortic bifurcation with 9 mm self-expanding stent extension into EIAs, preserving IIA flow.

OUTCOME: Technical success with restored femoral pulses; no immediate complications.

CONCLUSION: Successful complex aortoiliac recanalisation using combined subintimal and re-entry techniques with kissing stent reconstruction.

KEY LEARNING POINTS: Combined antegrade–retrograde access improves success in complex occlusions; Re-entry devices are valuable when spontaneous re-entry fails; Kissing stent reconstruction is effective in small-calibre aortic bifurcations; Preservation of IIA flow should be considered where feasible.
Alternate strategies could include: Aorto-bifemoral bypass; CERAB.