56-year-old male, a lifelong smoker, presents with severe bilateral lower extremity claudication. At the initial visit, medical management and risk factors were addressed. Trial of management with Pletal failed at 1 month due to side effects. The patient's employment was at risk due to limitations in walking. CT angiography showed left external iliac, common femoral, and superficial femoral artery occlusions. Endovascular therapy was performed with angioplasty and stenting the left EIA and JetStream atherectomy of the left CFA. At 31 months, the left EIA and CFA remain patent.