Background: Endovascular treatment (EVT) is considered as an effective treatment in patients (pts) with critical limb ischemia (CLI). With the recent improvement of device and EVT technique, the success rate of chronic total occlusion (CTO) in distal aorta and ilio-femoral artery is increasing; however, the mid to long-term durability between distal aorta and ilio-femoral artery CTO following successful recanalization is not clarified yet. Methods: A total 187 consecutive CLI patients (pts) were treated by EVT from September 2004 to September 2010. Out of 187 pts, 57 pts (79 limbs, 95 lesions) underwent successful CTO intervention in either distal aorta or ilio-femoral artery. CTO recanalization was done either by true lumen angioplasty (shorter lesion) or subintimal angioplasty (longer lesion) with/without reentry device. Provisional stenting was done once the balloon angioplasty outcome is not optimal, mainly by self-expanding nitinol stents. Periprocedural complications and major clinical outcomes of CTO group (n=82 pts) were compared with those of non-CTO group (n=79 pts) up to 12 months. Results: Baseline clinical and procedural characteristics were similar between the two groups. Mid-term primary patency was approximately 90% and angiographic outcomes were similar between the two groups. Major clinical outcomes including mortality, repeat revascularization and the incidence of surgical intervention were similar between the two groups (Table). Conclusion: Once the CTO lesion in distal aorta was successfully treated, major mid-term angiographic and clinical outcomes were similar to those of iliofemoral CTO lesions. Long-term follow up with larger study population will be needed to get the final conclusion.