Objective: To investigate the effectiveness and feasibility of subintimal angioplasty/stent placement through retrograde popliteal approach for long superficial femoral artery sclerotic occlusion with failed recanalization by conventional endovascular antegrade approach. Methods: The data of fifty patients with long superficial femoral artery sclerotic occlusions, in whom the guide wire and catheter failed to advance into the distal true lumen through the occlusive lesions by antegrade ipsilateral or contralateral femoral approach, and then underwent subintimal angioplasty by retrograde popliteal approach were analysed. Results: The immediate success rate of stent placement was 100%, with primary and secondary patency rate of 48.0% and 92.0% at 12 months. In all the patients, the ankle brachial index (ABI) was increased and Rutherford classification was improved significantly compared with those before operation (all P<0.05). Postoperative limb swelling occurred in 5 patients and popliteal pseudoaneurysm developed in 3 patients at 3 months after operation, which were all improved after treatment. Restenosis occurred after one year in 16 patients (32.0%). Conclusion: Subintimal angioplasty/stent placement through retrograde popliteal approach is effective and feasible in treatment of long superficial femoral artery sclerotic occlusion with failed recanalization after conventional endovascular antegrade approach.