72 year old gentleman presents with non-healing L foot dorsal aspect ulcer with claudication at rest (Rutherford Class III – Category V). His past medical history includes Hypertension, Dyslipidemia, Coronary Artery Disease s/p PCI to LAD in 2009, Chronic Kidney disease (Cr 1.9) and Insulin dependent Diabetic Mellitus. His medications include Aspirin, Plavix, Metoprolol, Norvasc, Benicar, Glucophage, Zocor and Insulin. He underwent ABI that was 0.4 in left lower extremity and 0.9 in right lower extremity. US Duplex showed severe stenosis of L Tibio –peroneal trunk (TPT) and multilevel infra-popliteal occlusions. He underwent PTA of L TPT ON 11/25/2015. Now planned for Antegrade/Retrograde approach Percutaneous Transluminal Angioplasty of L AT and L PT (for complete revascularization of pedal arch).