Laser-assisted balloon angioplasty has been successfully performed in peripheral and coronary arteries; however, the ability to perform laser angioplasty alone without the need for subsequent balloon angioplasty has not been reported. In the present series, infrapopliteal and below-knee popliteal sole laser thermal angioplasty was successfully performed on 14 of 16 (88%) lesions in 10 patients. Initial clinical and hemodynamic improvement was observed in seven of 10 (70%) patients, with clinical failure noted in three nonsurgical candidates with poor distal vessel runoff. Short-term clinical follow-up (mean, 6 months) revealed 100% patency at the site of laser thermal angioplasty. Clinical success was maintained in five of seven (71%) patients; symptoms recurred in two patients who had undergone laser thermal angioplasty and adjuvant balloon angioplasty of superficial femoral artery lesions. Treatment of distal peripheral arterial lesions with laser thermal angioplasty alone is feasible; studies comparing it with conventional balloon angioplasty should be considered.