Flush occlusion of the superficial femoral artery (SFA) presents a significant challenge in endovascular revascularization due to the absence of a stump for antegrade wire access. The retrograde popliteal approach has emerged as an alternative strategy, offering a viable route for successful intervention. This review aims to evaluate the efficacy, safety, and outcomes of the retrograde popliteal approach in patients with flush SFA occlusions, while analyzing technical success rates, complications, and long-term patency. A comprehensive literature review was conducted, including studies investigating retrograde popliteal access for SFA flush occlusions. Data were extracted regarding procedural success, complication rates, and patient outcomes. Evidence suggests that the retrograde popliteal approach achieves high technical success rates, particularly in cases where antegrade access fails. Complications such as hematoma, arterial injury, and access-site infection remain infrequent but require careful monitoring. Long-term patency rates vary based on lesion characteristics and adjunctive therapies. The retrograde popliteal approach is a valuable technique for managing flush SFA occlusions, particularly in complex cases unsuitable for conventional antegrade strategies. Further prospective studies are warranted to optimize procedural protocols and improve patient outcomes.