The aim of this study was to evaluate the feasibility and durability of endovascular therapy (ET) and its role in limb salvage in patients with TASC D femorpopliteal lesions who presented by critical limb ischemia (CLI). Background: traditional treatment of TASC D femoropopliteal lesions in patients presenting with CLI has been used to be risk factor modification and bypass surgery. However, many of these patients have multiple comorbidities making them high risk for surgical intervention. On the other hand, advances in endovascular techniques and equipments, have made ET possible and with tolerable operative trauma. Patients and Methods: This is a retrospective case series analysis for all patients presenting with critical limb ischemia and TASC D femoropopliteal lesions in kasr AlAini teaching hospitals in the period from August 2013 to March 2015, for whom endovascular management was attempted to improve blood flow to the popliteal trifurcation because of high risk of open revascularization ASA American society of anaethesiologists(ASA) category 3 and 4. Results: Fifty patients were treated for TASC D lesions with mean age of 62.9 years and male preponderance of 76%. Seventy two percent of the patients presented with tissue loss and 28% by rest pain. The mean lesion length was 18.8cm. Two cases necessitated the use of re-entry device (Outback, Cordis Corporation, Miami Lakes, Florida, USA). Sixty five percent of patients had their lesions stented. Technical success was achieved in 92% of patients. There was one perioperative mortality and two wire perforations and one arteriovenous fistula (between the superficial femoral artery and vein) that were managed conservatively without further complications or surgical intervention and one retroperitoneal hematoma that was managed conservatively. There were ten (22.2%) major amputations during the follow-up seven of which (15%) in the first three months postoperative the other three were in the next 3 months. Primary patency was 73% (33/45) at 3 months and 55.5 % (25/45) at 6 months, however limb salvage was 84.4% (38/45) at 3 months and was 77.7 % (35/45) at 6 months. Conclusion: ET of TASC D femoropopliteal lesions is safe and effective in limb salvage in this moribund set of patients. Restenosis and reocclusion is common in these complex, lengthy lesions, regular follow-up by arterial duplex and ankle brachial index (ABI) is mandatory to early treat any restenosis before occlusions occur Key Words: TASC D, femoropopliteal, critical limb ischemia.