Backgroundand purpose To evaluate technical success as a predictor of patency of infrapopliteal angioplasty in diabetic occlusive lesions. Patients and methods This prospective study included 134 cases (critical limb ischemia 100%) that underwent tibial percutaneous transluminal angioplasty. The end point of followup was major adverse clinical outcome of the treated segment, which was defined as healing or clinical failure, that is, need for subsequent intervention such as endovascular or surgical revascularization or amputation. Follow-up period was 12 months. Results All patients passed uneventful intervention course, and technical success was reported in 128 (95.5%) cases with minimal complications in ∼36 (26.9%) cases. There was a significant correlation between major adverse clinical outcome and major tissue loss, lesion occlusion, subintimal intervention, and complications (P=0.0001, 0.002, 0.001, and 0.002, respectively). Conclusion There are many predictors of patency after infrapopliteal angioplasty in diabetic occlusive lesions, including patient risk factors. Moreover, type and site of the lesion and technical success may play a role. However, the most important predictors of patency are major tissue loss, lesion occlusion, subintimal intervention, or complications.