Babol University of Medical Sciences Caspian Journal of Surgery 3115-9087 1 4 2025 12 01 Managing Balloon Disruption During Below-the-Knee Angioplasty: Successful Endovascular Retrieval 162 170 733035 10.22088/caspjs.2025.2081359.1046 EN Pouya Tayebi Department of Vascular and Endovascular Surgery, Rouhani Hospital, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran. 0000-0002-6923-0221 Journal Article 2025 12 19 Peripheral arterial disease is a prevalent vascular condition that frequently necessitates endovascular interventions, such as balloon angioplasty, for revascularization. This case report presents the management of a 65-year-old male patient with critical limb ischemia and a chronic total occlusion in the anterior tibial artery. The procedure encountered a challenging complication when a monorail balloon used for crossing the lesion in the anterior tibial artery disrupted from mid-shaft, leaving a long segment inside the vessel. However, this complication was effectively resolved using an endovascular approach. The clinical implication of this case highlights the importance of adaptability and skill in managing unexpected complications during endovascular procedures. Proper guidewire management and careful balloon handling are essential in preventing additional damage to the vessel and achieving a successful outcome. https://www.caspjs.com/article_733035_4d11eb3039ac46e9feb8eb8f6a43e919.pdf