[Trial of device that is not approved or cleared by the U.S. FDA] (RESTOR-BTK)

Inclusion Criteria:

1. The subject is able and willing to comply with protocol requirements, has been informed of the nature of the study, and has signed the IRB-approved informed consent form (ICF).
2. Subject is ≥22 years of age at the time of enrollment/consent.
3. Subject has symptomatic peripheral arterial disease as defined by the Rutherford Clinical Classification (Category 2 "Moderate claudication" through Category 5 "Minor tissue loss - nonhealing ulcer, focal gangrene with diffuse pedal ischemia").
4. Peripheral artery disease in the affected extremity is confirmed by imaging including at least one of the following: catheter-based angiography (preferably selective, digital subtraction, with visible ruler), Computed Tomographic Angiography (CTA), Magnetic Resonance Angiography (MRA), and/or Duplex Ultrasound Sonography (DUS).
5. Approval of subject's anatomical eligibility by an independent Screening Committee.

Angiographic Inclusion Criteria

1. Study target lesion is in native de novo tibioperoneal trunk, anterior tibial, posterior tibial and peroneal arteries.
2. Reference vessel diameter(s) for subject's target lesion is ≥2.0mm and ≤5mm by visual estimate.
3. The target lesion is a severely stenosed segment of ≤100mm in length that involves the CTO(s).
4. The target lesion involves at least one CTO that is angiographically ≥99% stenosed.
5. Presence of angiographic distal run-off to the foot with the target lesion reconstitution at or above the ankle level.

6. More than one lesion may be treated during the study enrollment procedure under the following conditions:

   1. De novo non-CTO inflow lesion(s) in the iliac and/or femoropopliteal arteries that are treated using endovascular non-stent-based technique without complications (absence of flow-limiting dissection, perforation, distal embolization) prior to the initial investigational device insertion.
   2. De novo non-CTO inflow lesion(s) in the TPA, ATA, PTA and PA that are treated using endovascular non-stent based technique without complications (absence of flow-limiting dissection, perforation, distal embolization) prior to the initial investigational device insertion.
   3. Presence of >1 BTK CTO in the target artery with intervening angiographically opacified arterial segment would be eligible. The CTO that is sequentially first in the direction of the initial crossing attempt would be considered the study target CTO lesion for defining investigational device outcomes.
   4. Only one CTO in the target artery can be treated with AngioSafe Peripheral-5 CTO Crossing System (PER-5).

Exclusion Criteria:

1. Subject has a systemic infection or an infection in the extremity of the target lesion.
2. The target lesion is within native vein or synthetic vessel grafts or is in-stent occlusion.
3. The contralateral limb requires planned intervention concurrently with the study procedure.
4. The target limb requires intervention of a CTO in the inflow vessels concurrently with the study procedure.
5. The target limb requires traversing a stented segment with the investigational device (not contained within a sheath of delivery catheter) in the inflow vessels during the study procedure.
6. Subject requires planned intervention of the lower extremities after the study procedure within the timeframe for the 30-day follow-up visit.
7. Subject has a known coagulopathy or bleeding diatheses, thrombocytopenia with platelet counts less than 50,000/μl, or INR >1.7 (unless corrected prior to procedure, as verified by a lab test no older than 5 days prior to the investigational procedure).
8. Subject in whom antiplatelet, anticoagulant, or thrombolytic therapy is contraindicated.
9. Subject has known allergy to contrast agents or medications used to perform endovascular intervention that cannot be adequately pre-treated.
10. Subject has known allergy to nickel, titanium, urethane, nylon, or silicone.
11. Subject has history of myocardial infarction within 30 days prior to enrollment/consent.
12. Subject has history of stroke within 30 days prior to enrollment/consent.
13. Subject has chronic kidney disease (CKD) of stage 4 or greater based on an Estimated Glomerular Filtration Rate (eGFR) <30ml/Min unless the subject is on chronic renal replacement therapy.
14. Subject has baseline hemoglobin levels <10g/dL verified by a lab test no older than 14 days prior to enrollment, unless the subject has a history of chronic anemia at a stable level, no recent bleeding diathesis or history of blood transfusion in the last six weeks.
15. Subject is pregnant or nursing, for females of child-bearing potential (<50 years of age).
16. Subject is participating in another interventional research study that may interfere with study endpoints.
17. Subject has limited life expectancy or co-morbid conditions, or social/psychological problems that, in the opinion of the Investigator, will preclude them from participation and completion of study procedures or requirements.
18. Subject is presenting with acute limb ischemia (ALI).
19. Subject has had a prior unsuccessful attempt to cross the target lesion within 30 days.
20. Subject has had a procedure on the target limb or contralateral limb within 7 days.
21. Subject has had a procedure on the target limb or contralateral limb within the past 30 days and is unstable per the site investigator(s).