Background For long totally occluded lesions of lower limb arteries treated with conventional intraluminal angioplasty, the success and patency rates are poor. Also, bypass surgery is not often suitable for patients with multi-segmental long occlusive lesions of lower limbs. Therefore, we investigated feasibility and clinical outcomes of subintimal angioplasty for multi-segmental long occlusive lesions. Method We evaluated immediate and mid-term outcome of 32 patients (20 male, mean age; 67 years, range; 49 to 82 years) who underwent subintimal angioplasty from 2003 to 2004. The baseline and follow-up clinical data, ankle brachial index (ABI), CT angiograms were evaluated. Results Thirthy-two patients presented severe claudication (65.5 % - Fontain IIb) or critical limb ischemia (35.5 % - Fontain III or IV). Eighteen patients (56 %) had type II diabetes mellitus and 19 patients (59 %) were smoker. All patients presented with total occlusion of more than two major arteries at one lower extremity. Immediate procedure success and complication rate (perforation: 1, hematoma: 2) was 87.5 % and 9 %, respectively. Stents were deployed at proximal subintimal entry site in 27 patients (96 %) and all patients received combination of aspirin and pletaal or plavix. Baseline and follow-up data are shown in Table. Conclusion Subintimal angioplasty is feasible with acceptable mid-term clinical outcomes and can be considered especially for patients with multi-segmental long lower limb artery occlusions who are poor candidates for bypass surgery.