BACKGROUND: Subintimal percutaneous transluminal angioplasty(SI-PTA) is one of the treatment options for long segment occluded lower limb artery. However, the long-term clinical results are not well known. We investigated the feasibility and clinical outcomes of SI-PTA in patients with long occlusive lesions of SFA. METHODS: 36 patients with 43 vessels (35 male, 69짹8 years) with severe claudication (Fontine category IIb, n=25) or critical limb ischemia (CLI; Fontine III or IV, n=18) were treated by SI-PTA with/without stenting for long (mean 26짹9 cm) total occlusion in SFA. Clinical follow-up was performed during mean period of 14 months. Primary patency of 12 months was assessed by peripheral angiography, CT or duplex ultrasound exam. RESULTS: Of the 43 SI-PTA attempts, 39(90%) were initially successful, with an increase in the ABI from 0.41짹0.28 to 0.89짹0.16 (P=0.02). The 4 technical failures were due to inability to advance the wire (n=1), to re-enter the distal lumen (n=2), and flow limiting dissection (suboptimal, n=1), respectively. Stent implantation was performed 35 (90%) of the 39 initially successful SI-PTAs. Two (4.6%) complications occurred (1 hematoma, 1 flow limiting dissection) but did not require surgery. Two (5%) patients died from non-cardiovascular causes and three (8%) limbs were amputated, so, 1 year limb salvage rate was 87%. In-stent restenosis (ISR) were developed in 13 (33%) lesions. In patients with ISR, initially 9 lesions were treated with re-PTA and 4 lesions were treated with bypass surgery. Follow-up ABI at 12 months after successful SI-PTA was 0.76짹0.24. Stent fracture was developed in four (10%) patients. One patient mildly fractured stent showed good patency without symptom recurrence, three patient critically fractured stent was treated successfully with bypass surgery or re-PTA . CONCLUSION: SI-PTA may be used for limb salvage with a relatively high success rate and acceptable outcome in patients with severe lower extremity occlusive vascular disease.