71 year old woman presented with R LE 2nd toe ulcer (at web) with claudication at rest (Rutherford Class III – Category V). Her past medical history includes Hypertension, Dyslipidemia and Insulin dependent Diabetic Mellitus. She underwent Directional Atherectomy and PTA of LSFA in July 2015. Her medications include Aspirin, Pletal, Metoprolol, Lotrel and Insulin. She underwent ABI that was 0.3 in right lower extremity and 0.8 in left lower extremity. US Duplex showed severe stenosis of right Superficial Femoral Artery (RSFA) and RAT and RPER infrapopliteal vessel occlusions. Now planned for Antegrade/Retrograde approach Percutaneous Transluminal Angioplasty of RSFA and R AT (based on US Duplex).