A 60-year-old woman with intermittent claudication underwent angiography, which showed total occlusion of the left superficial femoral artery and no distal flow. Computed tomography with contrast medium revealed that the occlusion extended to the popliteal artery but distal flow was maintained to the dorsalis pedis artery. Percutaneous transluminal angioplasty was attempted via the right femoral artery, but the guidewire could not be advanced. Therefore, a 4F sheath was inserted into the dorsalis pedis artery and the guidewire was passed through the occluded lesion. After pre-dilation, the guidewire was re-crossed from the right femoral artery and two stents were successfully implanted. Finally sufficient antegrade blood flow was achieved after the procedure. The trans-dorsalis pedis artery approach is a valuable option for the percutaneous transluminal angioplasty of long superficial femoral artery occlusion if the antegrade approach is impossible.