- Relevant clinical history and physical exam:
A 62-year-old man suffered from left severe claudication over 3 months was admitted. He had a history of amputation of right 4th toe 2 years ago, diabetes, hypertension, end-stage renal disease on hemodialysis.

- Relevant test results prior to catheterization:
CT angiography showed significant stenosis of dital anterior tibial artery (ATA).
Ankle-brachial index : right 0.69, left 1.45 (before Rt PTA).

- Relevant angiography findings:
The diffuse, significant stenosis in the dital ATA and proximal posterior tibial artery were revealed. ( Movie 1)

- Procedural step:
A 7 Fr sized femoral long sheath was inserted into the left femoral artery. We passed the proximal stenosis of PTA with VP-18 0.018” control wire but could not pass the distal segment.(Figure 1) We left it be and wired the ATA. The proximal lesion of ATA was dilated with a 2.5 * 100 mm Symmetry balloon. Finally, we achieved good flow in ATA.(Figure 2, Figure 3, Figure 4)