Aim: To assess the primary patency of the tibial vessels after using long dilatating balloon catheters in below the knee angioplasty in patients with critical limb ischemia, and its effect on limb salvage rates. These results were compared with previous literature results of treating tibial lesions using short balloon catheters. Patients & methods: Twenty (20) patients with critical lower limb ischemia essentially attending the vascular out-patient clinic and the emergency department of Ain Shams University Hospitals from December 2012 till December 2014 were included in the study. Patients were treated by long balloon catheter and the primary patency of this procedure, and its effect on limb salvage were assessed. Results: The technical success rate was 95%, while primary patency rate after one year was 75% for patients treated by long balloon catheters for multi-segmental long tibial lesions in below the knee angioplasty. Limb salvage rate was 90% after one year. Comparison with results from previous literature using short balloons in the treatment of tibial lesions revealed no significant difference as regard technical success rate, primary patency rate or limb salvage rate. Conclusion: Infrapopliteal angioplasty with a long balloon was feasible, with encouraging midterm outcome, in the treatment of severe limb ischemia. The advantage of long balloons is that it can easily treat complex long lesions with a single balloon covering complicated anatomy of the most of the lesion area, resulting in better arterial remodeling, also, decreased procedural time and decreased radiation exposure.