Background竊�Endovascular therapy (EVT) in infrapopliteal arteries has been proven to lead to limb salvage with low morbidity and mortality in patients(pts) with critical limb ischemia (CLI). Because of the high prevalence of recurrence and technical difficulties, the EVT in infrapopliteal arteries are still challenging.Method: A total of 128 consecutive CLI pts were included from June 2004 to November 2008. Out of 128 pts, 39 pts underwent infrapopliteal intervention with 5Fr Heartrail catheter and 0.14��� coronary balloon system. Under the successful wiring either by subintimal angioplasty or true lumen angioplasty using 035 soft Terumo wire, 5Fr Heartrail catheter was introduced or 014 coronary balloon systems have initiated. Procedural success, periprocedural complications and clinical outcomes up to 12 months were analyzed. Results: The baseline characteristics demonstrate that the mean age was 67.3짹7.5 years old, and diabetes was in 76.9% (30/39). Out of 66 pts with infrapopliteal lesions, 58pts underwent tibial and 8 pts peroneal percutaneous transluminal angioplasty (PTA). Concomitant iliac PTA was performed in 3 pts (7.6%), femoral 14 pts (35.8%) and popliteal 15 pts (38.4%). Eleven pts (21/60, 53.8%) had CTO lesions and mean lesion length was 82.9mm. Overall procedural success was achieved in 39 pts (38/39, 98.3%). Non-critical periprocedural complications were developed including 6 dissections (16.7%), 2 abrupt closure (3.3%), 2 no reflow (3.3%), 3 acute thrombosis (5.0%) and 2 perforation (3.3%). 5F Heartrail catheter was extremely useful to reduce acute recoil, thrombosis and managing wire-induced perforation. At 6 month, only 5 pts underwent repeat PTA due to recurrent CLI (12.8%), 16 pts wound debridement (30%) and 2 pts partial amputation (5%). Conclusion: Infrapopliteal artery intervention in pts with CLI using 5Fr Heartrail catheter system and 0.14��� coronary balloon system appears to be safe, showing excellent and durable immediate and mid-term clinical outcomes without critical complications.