Percutaneous peripheral laser thermal angioplasty with a laser-heated metallic-capped fiber was used as an adjunct to conventional balloon angioplasty. Initial angiographic and clinical success was achieved in 99 of 129 (77%) femoropopliteal stenoses and occlusions (21 of 22 [95%] stenoses, 17 of 17 [100%] short [1-3-cm] occlusions, 26 of 37 [70%] medium-length [4-7-cm] occlusions, and 35 of 53 [66%] long [greater than 7 cm] occlusions). There was a 4% frequency of vessel perforation without clinical sequelae and no necessity for emergency bypass surgery. The 1-year cumulative clinical patency was 77% for the 99 lesions with an initial clinical success. In the 21 stenoses and 17 short occlusions, the cumulative clinical patency rates were 95% and 93%, respectively. In the longer occlusions (4-7 cm and greater than 7 cm), the clinical patency rates were 76% and 58%, respectively. The initial angiographic and clinical success, as well as the 1-year cumulative clinical patency, for stenoses and short occlusions after laser-assisted balloon angioplasty may be greater than after conventional balloon angioplasty alone.