Background: peripheral arterial disease (PAD) is defined as a slowly progressing, occlusive vascular disease of the extremities primarily due to atherosclerosis which can involve vasculitis and thrombosis. The incidence of PAD is increasing worldwide due to an overall increase in diabetes, obesity, and other cardiovascular disorders. Objective: the purpose of this study was to compare the outcomes, including the safety, of antegrade and retrograde puncture for SFA angioplasty access especially when lesion occurs in proximal part of SFA. The effect of these approaches upon procedure time and radiation dose was also assessed. Patients and Methods: a group of 40 consecutive patients (19 men, 21 women) were randomized for antegrade puncture or retrograde puncture of the common femoral artery. Following retrograde puncture the guidewire was turned' and placed into the superficial femoral artery. The time for gaining access, screening time, radiation dose, and complications were recorded. Results: there was no significant difference in the time to achieve arterial access between the two groups but the retrograde puncture required a substantially longer screening time and resulted in a higher radiation dose than antegrade puncture. Conclusion: antegrade puncture is the standard means of obtaining access to the common femoral artery to carry out infrainguinal intervention. The antegrade approach has the advantage of permitting the use of shorter tools, and additional support for manipulating catheters and guidewires.