Purpose : The purpose of this study was to determine the safety and efficacy of the percutaneous transluminalangioplasty(PTA) in patients with chronic arterial occlusive disease below the knee joint. Materials and Methods :We retrospectively analyzed the results of 36 procedures in 16 patients. There were 15 men and one woman, aged57-75 years(mean, 62 years). Indications were disabling claudication(SVS/ISCVS grade 1, category 3) in five cases,rest pain(grade 2, category 4) in three cases, and non-healing ulceration or gangrene(grade 3, category 5) ineight cases. PTA was performed by using small vessel balloon catheter of 2-4 mm and 3 mm monorail balloon catheterin tibioperoneal vessels and 5-6 mm balloon catheter in distal popliteal artery and tibioperoneal trunk. Combinedthrombolytic therapy with Urokinase was performed in 14 patients. Results : Involved infrapopliteal vessels werefour distal popliteal arteries, 15 tibioperoneal trunks, six anterior tibial arteries, five posterior tibialarteries, and seven peroneal arteries. Technical success was determined when post-PTA angiogram showed less than30% of residual stenosis. Clinical success was defined as improvement of clinical symptoms, such as disappearanceof claudication or rest pain, and healing of ulceration. Technical success was achieved in 30 of 36 arteries(83%).Clinical success was achieved in 12 of 16 patients(75%) at an average follow-up of 13.3 months(range, 2-46months). Clinical success rate was 100% in grade 1 category 3 patients, 67% in grade 2 category 4 patients, and63% in grade 3 category 5 patients. Complication included two distal emboli, one vessel rupture, one vesselthrombosis, and one occluding intimal flap. Conclusion : PTA was an effective method for treatment of chronicarterial occlusive disease below the knee joint and considered as the procedure of first choice. Severeclaudicant(grade 1) should be included in the indication of the tibioperoneal PTA.