Symptomatic patients with total superficial femoral artery occlusions were approached with a modified Dotter technique followed by PTA and/or atherectomy. In 21 lesions studied, 7 (33%) were crossed with a conventional guide wire. Of the remaining 14 lesions (67%), 12/14 (86%) were crossed successfully using the pliable distal tip of the sheath introducer. The average angiographic lesion length crossed was 42 +/- 29 mm (range 8-109 mm). One insertion site vessel complication requiring surgical repair was seen. Although more advanced technologies have been developed to treat "wire resistant" total occlusions, the use of the introducer technique described is effective in many patients and adds no additional cost or time to the standard angioplasty procedure.