UNLABELLED: The aim was to evaluate the efficacy and safety of primary retrograde endovascular intervention in patients with necrotic lesions of the foot caused by chronic limb threatening ischemia. OBJECTIVE: The analysis of the results of 68 primary retrograde interventions in 64 patients with ischemic necrosis of the foot was performed. The average age was 69.2±9.7. Occlusion of the femoropopliteal segment occurred in 72.1% of observations. At least one crural artery was occluded in 79.4% of cases. There was a two-level occlusive lesion in 58.8% of observations, a three-level occlusion in 2.9%. Access was performed at the distal third of the crural arteries in 95.6% of cases. Access was performed through the sole patent crural artery in 25% of observations. The sole patent vessel was also feeding artery for affected angiosome in 14.7% of cases. Antegrade recanalization and angioplasty of the 'adjacent' crural artery were performed using primary retrograde distal access in 35 (51.5%) observations. The lesion of the 'adjacent' artery was represented by occlusion in 68.6% of cases. In addition, due to the presence of hemodynamically significant lesion of the proximal segment of the punctured vessel, in 27 (77.1%) observations angioplasty of two crural arteries was performed through the single access. RESULTS: Direct revascularization of the affected angiosome was achieved in 82.4% of observations. Blood supply to the ulcer was restored through the foot collaterals from the non-angiosome artery in 17.6% of cases. Angioplasty of the 'adjacent' crural artery was successful in 100% of observations. It was possible to perform intraluminal recanalization in 41.7% of cases of 'adjacent' artery occlusion (the average lesion length was 3 cm). In 58.3% of cases subintimal angioplasty was performed (the average occlusion length was 11 cm). Femoral access was required to successfully complete intervention in 5.9% of observations. Access site complications (7.4%) were local, occurred without any symptoms and in most cases (4 out of 5) were eliminated without loss of patency of the punctured artery. In one case active measures were not carried out due to good blood supply to the foot from other crural arteries. CONCLUSION: Primary retrograde endovascular intervention in patients with chronic limb threatening ischemia is effective and safe, including when performing through a sole patent crural vessel and/or when recanalization of the 'adjacent' artery through the distal single access is necessary.