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目的：探讨逆行穿刺内膜下成形术（SlA）对膝下动脉长段硬化闭塞症的治疗效果和临床应用价值。方法回顾性分析我院50例膝下动脉长段硬化闭塞症的临床资料，其中25例采用顺行SlA治疗为对照组，另25例在顺行SlA失败后采用逆行穿刺SIA对狭窄或闭塞性病变进行长球囊扩张为实验组，对手术前后两组患者的踝肱指数（ABI）、皮温进行组间及组内的比较分析。结果50例技术即时成功率均为100%，术后肢体缺血症状得到明显改善，无严重并发症发生。实验组患者ABI由术前的0.31±0.12增至术后24 h、1周、3月、6月及12月的0.47±0.09、0.56±0.06、0.63±0.07、0.58±0.06、0.49±0.03；皮温（T，℃）由术前的28.13±2.45增至术后24 h、1周、3月、6月及12月的33.87±1.24、34.16±0.44、34.19±0.25、32.45±0.25、31.05±0.21，术后24 h、1周、3月、6月及12月ABI与T分别与术前比较差异有统计学意义（P0.05）。结论逆行穿刺SIA治疗膝下动脉硬化闭塞症的临床成功率高、并发症少，是顺行SIA失败后治疗膝下动脉长段硬化闭塞症安全有效的方法。“,”Objective To assess the clinical efficacy of retrograde puncture subintimal angioplasty (SIA) for treatment of occlusive diseases in the long segment of the infrapopliteal artery. Methods The clinical data of 50 patients with occlusive diseases in the long segment of the infrapopliteal artery were retrospectively analyzed. The patients were divided into control group (n=25) and study group (n=25) and received antegrade SIA and retrograde puncture SIA with long balloon after the failed antegrade SIA, respectively. The ankle brachial index (ABI) and the temperature of the infrapopliteal skin before and after the operation were compared between the two groups. Results The technical success rate was 100% in the 50 patients, who showed obviously improved ischemic symptoms without serious complications. The ABI of the study group increased from 0.31±0.12 before the treatment to 0.47±0.09 at 24 h, 0.56±0.06 at 1week, 0.63±0.07 at 3 months, 0.58±0.06 at 6 months, and 0.49 ± 0.03 at 12 months after the treatment, and the skin temperature increased from 28.13 ± 2.45 before the operation to 33.87 ± 1.24, 34.16 ± 0.44, 34.19 ± 0.25, 32.45 ± 0.25, and 31.05 ± 0.21 at the corresponding time points after the treatment, respectively, showing significant improvements after the operation (P0.05). Conclusion Retrograde puncture SIA is safe and effective for treatment of arteriosclerosis obliterans in the infrapopliteal arteries with a high clinical success rate and a low complication rate after the failure of antegrade SIA.