Critical limb ischemia (CLI) is associated with significant morbidity, mortality, and diminished quality of life. Infrapopliteal (below-the-knee [BTK]) peripheral vascular disease is frequently the sole or a contributing cause of CLI. Unfortunately, successful and durable revascularization for BTK vascular disease has been difficult to achieve. Schmidt et al. examined the results of angioplasty for long (>80 mm) infrapopliteal lesions ( n = 77) and reported 3-month angiographic restenosis in 68.8% of patients with a 37.6% re-occlusion rate . A meta-analysis including 52 studies of patients treated with angioplasty for symptomatic infrapopliteal disease (6769 patients and 9399 lesions) reported a technical success of 91.1% (95% confidence interval [CI] 88.8% to 93.0%), one-year outcomes included; primary patency of only 63.1% (95% CI 57.3% to 68.6%), incidence of repeat revascularization 18.2% (95% CI 14.5% to 22.6%), major amputation rate 14.9% (95% CI 12.3% to 18.0%), and an all-cause mortality of 15.1% (CI 12.8% to 17.7%) . Another meta-analysis of 44 studies examining revascularization for infrainguinal CLI (8602 patients) also reported low one-year patency rates for angioplasty (66%), bare metal stents (BMS) (50%), and drug-eluting stents (DES) (73%) with declining patency at 3 years (10% for BMS and 49% for DES)