Introduction: In recent years, endovascular treatment of long-segment superficial femoral artery (SFA) occlusive disease (> 15 cm) (Trans Atlantic Inter-society Consensus TASC lesions type C and D) has gained wider acceptance, representing a less invasive treatment option. Technical success rates have progressively improved to range from 80 to 95%, due to the introduction of specifically designed guidewires and low-profile balloon catheters. Aim of the work: Evaluation of the endovascular in treatment of TASC D femoro-popliteal occlusions in patients who might be at high surgical risk for open surgical interventions, as regarding: feasibility, clinical assessment of results, short-term patency and complications. Method: This is a prospective study conducted on patients presenting to the department of vascular and endovascular surgery, Kasr Alaini hospital, Cairo University along the period from September 2013 to December 2014. The aim of this study to assess the technical success and clinical outcome for six months after endovascular treatment of femoro-popliteal arterial disease TASC- D lesions in patients suffering from critical limb ischemia (CLI) and lifestyle-limiting claudication i.e. (Rutherford category III or more). Results: We received 30 patients; 22 males (73.3%) and 8 females (26.7%) with age range from 49 and81 years (mean: 64.3±7.4 years). 6 patients (20%) presented with lifestyle limiting claudication (Rutherford 3), 13 patients (43.3%) presented with rest pain (Rutherford 4), 16 patients (53.3%), presented with non-healing ulcers (Rutherford 5) with or without rest pain and 8 patients (26.7%) presented with gangrene proximal to the metatarsal bones (Rutherford 6). All the lesions were TASC D femoro-popliteal occlusive disease (100%). Lesions were classified into three groups according to the site of the occlusion: 21 patients have SFA occlusion (70%), 5 patients have popliteal occlusion (16.7%), while 4 patients have combined SFA & popliteal occlusion (13.3%). 50 %( 15 patients) have runoff on three vessels, 30 %( 9 patients) have run off on two vessels, and 20 %( 6 patients) have run off on one vessel. Angioplasty was done in all cases with conventional semi-complaint plain balloons. Selective stenting using self-expanding nitinol stents was done in 17 cases only (63%); the stents diameters ranged from 4 to 6 mm with mean stent diameter (5.9 ± 0.5 mm) and the stents length ranged from 60 to 150 mm with mean stent length (102 ± 28 mm). Additional sites for angioplasty and stenting were done in 9 cases; Tibial angioplasty for the Infrapopliteal tibial vessels in 8 cases (26.7%), and primary stenting for Common iliac artery (CIA) stenosis in one case only (3.7%). No major complications in the form of acute thrombosis, distal embolization, retroperitoneal bleeding or major amputation were observed. Minor complications occurred in 4 patients (13.3%); one patient (3.3%) has groin hematoma that was treated conservatively, two patients (6.7%) have minor perforation that was treated with prolonged balloon inflation and one patient (3.3%) has sheath thrombosis (sheath was removed and cleared and any residuals were aspirated by 6F catheter). Immediate technical success was achieved in 27 cases (90%). Conclusion: TASC D lesions can be treated using the simple endovascular means with acceptable results concerning limb salvage due to its ability to significantly improve distal extremity perfusion pressure with high technical success rates and minimal morbidity and mortality. Keywords: Endovascular, TASC D Lesions, Femoro-popliteal, Feasibility