Background: An endovascular therapy of aortic occlusive disease could be a good alternative treatment to the surgery. However, there were limited literatures about total occlusion of aorta. So, we investigated procedural and clinical outcomes of endovascular therapy of total occlusion of infra-renal aorta. Methods: We retrospectively evaluated outcomes of endovascular treatment in 54 patients (44 men; mean age 64.4짹11.0 years) with infrarenal aortic total occlusion between January 1995 and December 2009. Results: Technical procedural success was achieved in 48 (88.9%) patients. Reasons for procedural failures were inability of wire passage in 4 patients and large burden of thrombus in 2 patients. Forty patients underwent stent implantation, 7 were treated with balloon angioplasty alone and one patient was treated only by local thrombolytic therapy. Procedure-related major complications occurred in 5 (10.4%) patients: One died due to aortic rupture the day after the procedure, 2 had serious neurologic complications of spinal cord infarction and cerebral infarction, 1 had iliac artery rupture after balloon dilation which was treated with a graft-stent and 1 had distal artery embolizations which required embolectomy using Fogarthy athrectomy device. The overall rate of acute distal embolizations during procedure was 11.1% (6 patients). The mean follow-up duration was 32.4짹26.3 months (range to 13 years) and 8 patients (16.7%) were followed for 10 years. Among 48 patients who achieved procedural success, 5 (10.4%) patients required repeat intervention (n=2) or bypass surgery (n=3) during the follow up period (mean 32.4짹26.3 months). Primary patency rate was 95% at 1 year, 85% at 2 year and 81% at 3 year. Conclusion: Technical success rate and long-term outcome of endovascular treatment for aortic total occlusive lesions are acceptable. However, more preventive measures to avoid complications may be required for the endovascular therapy of aortic occlusion.