This paper describes the use of a 100u second pulsed Nd-YAG laser at 1.064 um wavelength in the treatment of critical ischemia of the lower limb in five human subjects. Laser energy was delivered percutaneously to superficial femoral artery occlusions using standard angiography access techniques. The fiber tip was modified by the use of a 2.2mm hemispherical sapphire tip in contact with the tissue and laser energy was delivered at 0.5 Joules per pulse at a repetition rate of 10Hz. Patients were selected because of their unsuitability for standard treatment, either through technical inoperability of poor general health. Their mean age (±SD) was 74 ± 11 years and the mean occlusion length (+SD) in the five patients was 16.3 ± 11.9 cm. Passage of a guidewire across the occlusion was attempted, but failed, in every case. The laser crossed all these occlusions with a mean energy delivery of 129 + 76 Joules. Mean ankle-brachial pressure index (ABPI) in the successful cases doubled from 0.25 to 0.5. Two of the recanalised segments closed within 24 hours due to poor runoff but remained open in the remaining three patients for a followup period of up to one year, averting amputation in one of them. These are poor risk patients with deteriorating critical ischemia and little hope of alternative treatment. Laser angioplasty using a pulsed Nd-YAG laser has been shown to be feasible in femoropopliteal disease and should now be applied in patients with less severe symptoms.