Background: Critical limb ischemia occurs when the blood flow to the leg is insufficient to maintain the metabolic requirement of the tissue in the resting state. Objectives: This study was to describe the technical aspects of the retrograde approach as an alternative for failed antegrade access for difficult below the knee chronic total occlusions. Patients & Methods: This study was conducted as retrospective and prospective interventional study that included 18 patient with CLI of deferent ages and sex who were admitted to the department of vascular surgery at Zagzaig university Hospitals. Results: we can deduce the major predictive values of technical and clinical success related to endovascular intervention which were lesion characteristics represented in its length and nature, picture of presentation and co-morbid conditions. Conclusions: Retrograde tibiopedal approach can be used safely as a bailout to increase the technical success rate and limb salvage for failed antegrade recanalization of popliteal and infrapopliteal arterial occlusions.

Background: Breast reduction remains a commonly performed operation, with more than 122,000 breast reductions performed in 2013 (American Society for Aesthetic Plastic Surgery (2014). Breast reduction, also known as reduction mammaplasty, is a procedure to remove excess breast fat, glandular tissue and skin to achieve a breast size more in proportion with the body and to alleviate the discomfort associated with excessively large breasts (macromastia). Aim of the study: was to evaluate the short-time outcome effects of superomedial pedicle using Hall-Findlay's technique of the breast reduction, to evaluate the effects on operative time, short-time outcome, the short-term effects and the complication rate of superomedial pedicle of the breast reduction. Methods: A total of 12 consecutive patients with bilateral breast hypertrophy underwent superomedial pedicle breast reduction in Plastic Surgery Unit, Zagazig University Hospital were included in this study during the year 2018. The operation was performed according to Hall-Findlay superomedial pedicle technique. All operations were performed by a double team of surgeons, with each team including a resident and a senior surgeon who was the leader of the operation. Results: Superomedial pedicle can be safely utilized in large size breast reduction without an expanded danger of NAC. Conclusions: The Hall-Findlay technique has aesthetic results and low complication rates in patients underwent breast reduction. We plan to expand the patient population that can undergo this technique, so more patients can benefit from its advantages.