In patients with rest pain, tissue loss and ulceration, angioplasty is now commonly regarded as the first line of therapy. Many of these patients have significant comorbid disease and are at high risk concerning general anaesthesia. Infrapopliteal angioplasty can be performed without compromise to potential distal graft anastomoses and has a very low associated morbidity and mortality. The objective of below-knee limb salvage angioplasty is to restore "in-line" flow to the foot arches if possible. By using conventional 5 Fr systems, vessels down to 3 mm diameter can be treated. The availability of low profile balloons based on 0.018 and 0.014 inch guide wire allows balloon dilatation of vessels as small as 2mm in diameter. Also the technological development in angioplasty equipment allowed the use of many devices in tibial angioplasty including atherectomy devices (Silverhawk and Rotablator), cutting balloon, angiosculpt balloon, frontrunner catheter, cryoplasty and the use of excimer Laser.