74 year old woman presents with left leg life style limiting claudication (Rutherford Grade II – Category III, Fontaine stage IIB). Her past medical history includes Hypertension, Hyperlipidemia, CKD stage III (Cr 1.6) and ex-smoker. Her medications include Aspirin, Pletal, Plavix, Labetalol, Amlodipine and Lipitor. She has known PAD (underwent RSFA CTO intervention in 2015). She underwent ABI that was 0.9 in right lower extremity and 0.5 in left lower extremity. US Duplex showed CTO of LSFA (occluded at ostium) with occluded LPT and LPER and moderate stenosis of LAT. She underwent diagnostic peripheral angiogram which showed CTO of LSFA occlusion at ostium with 1 vessel runoff. (Staged for elevated creatinine) Here for Percutaneous Transluminal Angioplasty of LSFA (pedal access if needed).