Abstract Background: Diabetes is one of the strongest predictors of Peripheral Arterial Disease (PAD). It is associated with two fold increase of relative risk of PAD. Aim of Study: To evaluate passage route as predictor of outcomes of tibial angioplasty in diabetic patients. Patients and Methods: This prospective study included 67 cases of chronic limb threatening ischemia patients (CLTI 100%) underwentinfra genicular angioplasty. Our main interest was to determine adverse clinical events such as clinical failure, need for redo interventions and/or amputation. Results: Almost 91% of our cases (61/67 patients) had a positive history of hypertension that did not seem to be a significant factor of Major Adverse Clinical Outcome (MACO). Foot lesion i.e. ulcerationmay predict MACO. Intraluminal route was performed in 58 (86.6%) cases and via subintimal route in 9 cases (13.4%). In the patients operated upon via intraluminal route, twelve patients developed MACO. These results were of significant statistical value; p-value; 0.020. Conclusions: Foot lesion i.e. ulceration; the larger the wound size or the volume of tissue loss may predict MACO in addition to successful passage route either transluminal or subintimal route inbelow knee PTA is consideredpredictors of adverse outcome.