Critical limb ischemia is associated with high rates of limb loss & mortality. Within 6 months of presentation with CLI, ?25% of patients will require major amputation. An estimated 250,000 major amputations are performed annually in the United States & Europe, resulting in a significant socioeconomic burden & reduction in quality of life indicators. Published rates of mortality for CLI approach 25% at 1 year & >50% at 5 years. Among revascularization methods, surgical bypass has been regarded as the gold standard, with better anatomical and clinical durability. However, patients with CLI are often aged & not optimal candidates for surgical bypass due to medical co-morbidities. This has rendered minimally invasive procedures superiority in the recent era. Interventional therapy for tibial arteries is a key part of the vascular specialist armamentarium. Tibial artery interventional therapy has been proven to lead to limb salvage with low morbidity and mortality in patients with CLI & should be used as a first line treatment in the majority of patients, especially in those with significant medical co-morbidities. This project aims at comparing different modalities for intervention.