Noticing more Rutherford 4–5 PAD showing up after prolonged claudication and wound care delays; are others seeing this trend? We’ve leaned on ultrasound-guided retrograde pedal/tibial access with intraluminal angioplasty and limited atherectomy under local to keep procedures under an hour and reduce admission time. Last Tuesday we revascularized three limbs via pedal puncture in the angio suite with duplex roadmapping to limit contrast — are you favoring this over distal bypass in comparable risk profiles?