75-year-old female patient with past medical history of hypertension, dyslipidemia, diabetes mellitus type II, and prior MI, came in with complaints of right calf pain on minimal exertion (Rutherford class I category 3, Fontaine IIb) on cilostazol. MRA showed bilateral SFA occlusion with distal reconstitution. Peripheral angiogram performed showed borderline stenosis of the right external iliac artery, severe calcified long segment CTO (chronic total occlusion) of proximal/mid/distal right superficial femoral artery (SFA), distal reconstitution of the proximal right popliteal artery via the profunda collaterals (shown in picture 1, 2, & 3), CTO of the mid right anterior tibial artery with distal reconstitution of the right dorsalis pedis artery via the peroneal artery collaterals, CTO of mid left SFA with distal SFA reconstitution, CTO of the mid left anterior tibial artery with distal reconstitution of the left dorsalis pedis artery via the peroneal artery collaterals. Patient is currently planned for an endovascular intervention of the long segment calcified SFA CTO (TASC D lesion). We will discuss the endovascular indications and approach towards the long segment calcified TASC D SFA lesions.