In Japan, increases in diabetes and chronic kidney disease have led to increases in the patients with critical limb ischemia (CLI). The therapeutic strategy in the patients with CLI is not as clearly established because of the severe complications such as cerebral infarction, myocardial infarction and local infection of the gangrene. Therefore, the patients with CLI has poorer prognosis and treatment of CLI patients is becoming a worldwide issue. In particular, Japan has many dialysis patients, who are a higher risk of developing CLI. Unfortunately, here in Japan we do not have foot specialists like other countries. As a result, diagnosis is often delayed, and doctors must treat very complicated and difficult cases. Recently, doctors in Japan began performing endovascular interventions, with cardiologists, vascular surgeons and plastic surgeons providing multidisciplinary treatment, and sharing evidence regarding limb salvage. In March of 2015, the Japan Circulation Society published revised 2015 guidelines on peripheral occlusive arterial disease treatment. Meanwhile, new device assessment indicators were created for new devices to treat CLI, and Japanese centers are taking part in global trials. In this session, we will look at current CLI treatment results in Japan and discuss the most suitable treatment system for CLI patients in Japan.