Background:Many patients with chronic lower limb ischemia (CLI) have either inadequate conduit or complex comorbid conditions with risks for surgery. Recent advances in equipment and technique have stimulated interest in infrapopliteal percutaneous transluminal angioplasty (PTA) Method:From June 2002 to August 2005, Intrapopliteal PTA was performed on 68 limbs of 63 patients (48 male; mean age 66 years, range 27-89) with intermittent claudication (Rutherford category <3, n=11 ) or critical limb ischemia (Rutherford category 4 or 5, n=52 ). Total 83 lesions were treated. Technical success was defined as PTA resulting in less than 30% residual stenosis with sufficient antegrade flow, and suboptimal result was recorded as sluggish flow and/or residual stenosis 30% ~ 50% after repeated dilatation. Primary clinical success was defined as an improvement of at least one clinical category with an increase in ABI of more than 0.10 after PTA. The primary patency was defined as an absence of symptom recurrence and target lesion revascularization during the follow up period. Result:Median follow-up was 22 months. Of the total 68 limbs, there were 48 (70%) successes and 3 (4%) failures due to unsuccessful guidewiring, also remaining 17 (26%) limbs presented suboptimal result on final angiogram. Minor procedural complications composed of dissection, rupture, and embolization were 11 in 83 treated lesions (12%), and these complications could be treated by bailout stent implantation or medical therapy. There was no other major complication requiring surgical intervention after PTA. Primary clinical success rate was achieved in 60 limbs (92%). Primary patency at 1 year and 2 years were 66.0% and 61.9%, respectively. Limb salvage at 1 year and 2 years were 98.3% and 93.2%. Survival rate at 1 year and 2 years were 85.9% and 67.1%, respectively, and main cause of deaths was acute myocardial infarctions. In Cox regression analysis, renal insufficiency was the only independent predictor of primary patency and overall survival in patients with CLI. Conclusion:Infrapopliteal PTA is a feasible treatment and provide favorable outcome with good primary patency and limb salvage rate in patients with chronic lower limb ischemia.