Accessing Peripheral Occluded LesiOns II (APOLO-II)

Inclusion Criteria: * Documentation from a previous attempt OR a concurrent reasonable attempt (at least 5 minutes) during this procedure, demonstrating resistance to conventional guidewire crossing; * Patient must have objective evidence of lower extremity ischemia; * Totally occlusive lesion in a native femoropopliteal artery classified angiographically as absolute (100% occlusion with no flow), where no antegrade filling beyond the occlusion is visible; * Target occlusion length is \>1cm and ≤ 30 cm; * Patient's reference vessel diameter is ≥ 4.0 mm and ≤6.0 mm (by visual angiographic estimation) * Patient must be an acceptable candidate for PTA, peripheral artery bypass surgery or peripheral artery stent implantation; * Female patients of child bearing potential must have a negative pregnancy test within 48 hours prior to the study procedure; * Patient must have been informed of the nature of the study, agree to its provisions, and provide written informed consent; * Patient is ≥ 21 years of age. Exclusion Criteria: * Patient has hypersensitivity or contraindication to aspirin, heparin, Plavix or radiographic contrast agents which cannot be adequately pre-medicated; * The patient requires immediate treatment in more than one occluded vessel, in any combination of grafts or native vessels; * Patient has planned femoropopliteal intervention scheduled within 30 days after index procedure; * The patient is currently participating in another investigational drug or device trial that may conflict with study data collection and has not completed the entire follow-up period; * Patient has no collateral flow distal to the occlusion; * Patient's target occlusion has a dissection that occurred within the past 30 days caused by a guidewire attempt; * Patient has a history of bleeding diatheses, coagulopathy or will refuse blood transfusion in cases of emergency; * Patient suffered recent (within the past 6 months) significant gastrointestinal (GI) bleeding; * Patient's target lesion or the vessel proximal to the target lesion reveals significant ectasia, dissection, aneurysm or thrombus; * Patient has other medical illnesses (i.e., cancer or congestive heart failure) that may cause the patient to be non-compliant with the protocol, confound the data interpretation or is associated with life-expectancy less than 1 year.