Inclusion Criteria:

Clinical:

1. Age between 18 and 95 years.
2. Subject or subject's legal representative have been informed of the nature of the study, and have signed the patient informed consent form. Patient is willing to take part in the follow-up protocol of the XXS study.
3. Rutherford stage 4 and 5 Anatomical:

1. Additional lesions inflow lesions might be successfully treated before randomization and treatment of the target lesion. The inflow lesions which were treated before randomization should only be classified TASC A or B. (TASC= Trans Atlantic Intersociety Conference) 2. Target vessel with documented run-off to the foot distally of the index lesion with patent plantar arteries 3. Reference vessel diameter of the target lesion should be ≥ 2 and ≤ 5 mm. 4. Maximum treated length in the target vessel is 15 cm (might also be divided up into multiple segments with up to 3 different lesions being treated). 5. Maximum of treated vessels per leg below the knee: 2 (all treated vessels should be treated within the randomization to the study group [PTA or stenting]). 6. Minimum distance target lesion to talus is 5 cm.

Exclusion Criteria:

• Clinical

  1. Life expectancy due to a non-atheroslerotic disease less than 12 months.
  2. Previous bypass surgery < 30 days prior to the study procedure.
  3. Known allergies or sensitivities to heparin, contrast media, aspirin, clopidogrel, and nitinol which cannot be treated with antihistamines.
  4. eGFR less than 29 mL/min/1.73m2 (K-DOQI Class 4 and 5) in patients which are not currently treated with dialysis (equivalent to a serum creatinine level of 2.4 mg/dL in a 70 year old male patient)
  5. Subject with breast feeding plans, or child bearing potential with no birth control.
  6. Subjects enrolled in another study concerning the index vessel(s) within 3 months prior to the study procedure.
  7. Untreatable bleeding diatheses.
  8. Patients who have an indication of being treated with coumadin after the intervention.
  9. Inability to ambulate
  10. Hypercoagulable state
  11. Patients with age <18 years and patients who are not able to sign the informed consent form

Anatomical:

1. Inflow is obstructed and cannot be successfully treated prior to randomization and treatment of below the knee arteries.
2. Acute thrombus present in the target limb.
3. Previously implanted stent in the target vessel(s).
4. Aneurysms in the index leg.
5. Index vessel with no documented run-up to the foot (please also see inclusion criteria, anatomical).
6. Inability to use femoral access
7. No patent pedal arteries