Percutaneous transluminal angioplasty has been widely used for dilatation and recanalization of occluded or stenosed vessels, but clinical experience in Japan is not extensive. Follow-ups of 78 ilio-femoro-popliteal angioplasties were performed for up to 51 months to assess the initial and long-term results. The initial technical success rate was 91%. The three-year cumulative patency rate was 75%. This study demonstrates that the long-term results of PTA of ilio-femoro-popliteal arterial lesions are competitive with reconstructive surgery. PTA should be the treatment of choice in patients with atherosclerotic narrowing or occlusion of the lower extremities.