BACKGROUND ; Percutaneous intervention of an long segment occluded lower limb artery is one of the treatment options however, few data are available on this treatment and its effectiveness. To investigate the feasibility and clinical outcomes of subintimal angioplasty (SI-PTA) with/without stent implantation in patients with long occlusive lesions of femoropopliteal artery. METHODS: From March, 2006, until June, 2007, 48 patients (46 men; mean age 70짹8 years, range 43-82) with severe claudication (Fontine category IIb, n=38) or critical limb ischemia (CLI; Fontine III or IV, n=10) were treated consecutively with SI-PTA with/without stenting for long (mean 26짹9 cm) total occlusion in the lower limb arteries. Selective stent placement was performed after successful recanalization of the occluded arterial segments. Technical success was defined as restoration of distal blood flow with residual stenosis less than 30%. RESULTS: Of the 48 SI-PTA attempts, 45 (94%) were initially successful, with an increase in the ankle-brachial index from 0.5짹0.2 to 0.9짹0.1 (P < 0.001). The 3 technical failures were due to inability to advance the wire, and to re-enter the distal lumen, respectively. Forty-three (95%) of the 45 initially successful femoropopliteal SI-PTAs required placement of a stent, and 11 (23%) of the successful 45 SI-PTAs required additional PTA of 1 or more arterial segments. Two (4.1%) complications occurred (2 hematomas) but did not require surgery. Of the 45 successful SI-PTAs, 2 (4.4%) failed within 90 days, and the patients were treated successfully with re-PTA. Of the 43 patients with patent SI-PTAs at 90 days, 39 (82.1% of initial 48 patients) have remained patent with a mean follow-up 7짹4 months (range, 2-16 months). There were no perioperative deaths, and one patient has died during follow-up with patent SFA SI-PTAs. Angiographic restenosis rate and further clinical follow-up data will be presented. CONCLUSION: These data suggest that SI-PTA with stenting may be successfully used for limb salvage with a relatively high success rate and acceptable outcome in patients with severe lower extremity occlusive vascular disease.