Angiographic follow-up and clinical outcome of 126 patients after percutaneous directional atherectomy (Simpson AtheroCath) for occlusive peripheral vascular disease. Angiographic and clinical follow-up data were obtained in 115/126 patients who underwent directional atherectomy for peripheral vascular disease; of the 126, ten were excluded for appropriate reasons and one was lost to follow-up. Thus, 115/116 successful atherectomy patients (99%) had follow-up of 182/213 lesions (86%): 74 patients (64%) with angiography (mean time 5.4 mon), and 41 patients (36%) clinically. One hundred twenty-eight of 183 lesions (70%) had angiographic follow-up; the lesion recurrence as a stenosis or as an occlusion was 53%. Lesion distribution did not differ between angiography and clinical follow-up groups: nearly 85% were within the superficial femoral or popliteal arteries. Despite data stratification, angiographic follow-up indicated that patients after successful directional atherectomy, at a mean follow-up time of 5 mos, have more than a 50% lesion recurrence rate. Although directional atherectomy (Simpson AtheroCath) utilizing present techniques has excellent primary success and acceptable complication rates, angiographic follow-up statistics are bothersome. 