Peripheral artery disease (PAD) burdens a significant number of adult Americans and is associated with significant morbidity and mortality. The Transatlantic Inter-Society Consensus II (TASC II) guidelines standardize the degree of disease burden in individual vessel segments by assigning grades correlating to the complexity of lesion intervention. We sought data regarding endovascular approaches to lower extremity PAD in TASC C/D lesions in patients with claudication. Published data in these patients have demonstrated success in terms of procedural success, quality of life metrics, and intermediate to long-term primary patency rates. However, data have suffered from several methodological shortcomings including enrollment of heterogenous patient populations, inconsistent outcome reporting, and lack of appropriate control groups. The majority of data is positive in favor of using stent-based revascularization in both the aorto-iliac and femoral-popliteal arteries. Additionally, continual technological evolution in the field has resulted in a growing armamentarium for the endovascular operator beyond balloon angioplasty that aids in the success of endovascular intervention to these complex lesions.