Endovascular techniques began at early 60s where single point of entry into the vascular tree was used to transport devices to remote site aiming at dilatation of the peripheral arteries using balloons, “balloon angioplasty”. Balloon angioplasty, although being an effective methods for dilatation of stenotic segments yet it has its limitations specially in long segment stenosis and in totally occluded arteries. Compared with balloon angioplasty which disrupts the atheromatous plaque or stretches it away from the arterial wall, the advent of atherectomy devices (Rotablator), enables an actual reduction of the atheromatous plaque mass leaving a smoother surface and a smoother end points which are less liable to rethrombosis and restenosis.