We performed several techniques for chronic total occlusion (CTO) lesions in peripheral arterial disease (PAD). We evaluated the cases using the metal tip catheter (MT). We performed peripheral endovascular therapy (EVT) using MT in 31 cases 32 lesions of PAD from March 2007 to March 2011. Twenty-nine cases were CTO lesions using MT for back up of guidewire or MT alone in order to penetrate like a bougie with the blunt tip of MT. Two cases were acute arterial thrombosis for thrombectomy. Seven cases were CTO of the iliac artery (IA) and 25 cases were of the femoral artery (FA). Seven cases were in-stent restenosis. All 7 cases of IA were successfully treated with the initial techniques. We were unable to penetrate by MT(MT-) in 7 cases of FA, and in 2 cases out of the 7, we were even unable to cross the guidewire. Mean lesion length was 80 ± 42 mm in IA and 188 ± 88 mm in SFA. Among them, MT- was 164 ± 67 mm with no significant differences. Procedure time of EVT for CTO using MT was significantly shorter than other strategies. We had no complications such as perforation by using MT. MT provides high initial success rate by spectacular penetration performance and pushability. MT is a safe and effective device for CTO in PAD.