Background: Peripheral arterial disease (PAD) is a prevalent medical condition, reaching 20% among males in the 7 th decade, the associated morbidity and even mortality is more with critical limb ischemia (CLI) than with Intermittent Claudication (IC). Endovascular interventions have become more popular than open measures in treating PAD with less complications and more success rates. Aim: to evaluate the clinical outcomes of performing percutaneous transluminal angioplasty (PTA) in patients presenting with severe IC or CLI due to Trans-Atlantic Inter-Society Consensus (TASC)-D lesions. Patients and Methods: forty five patients with TASC D PAD were selected randomly; they performed PTA with balloon dilation with or without stenting for the lesions. Results: The mean age was 61.5 years, 74% males & 26% females. 28.9% presented with IC and 71.1% with CLI. The mean pre-intervention ABI was 0.45, reaching 0.69 after interventions (statistical significant improvement). Restenosis developed in 24.4% of the cases. Conclusion: Endovascular interventions for TASC II D lesions can be safely (minimal complications) performed with excellent hemodynamic improvement and limb salvage rates in this often medically unfit population.