Direct laser light, in combination with percutaneous transluminal angioplasty (PTA), was used to recanalize atherosclerotic peripheral arteries. Argon laser energy was controlled with an optical assembly and aligned with a special centering/dilation balloon so that plaque tissue absorbed laser energy directly and was vaporized. A channel was thereby created with multiple 10-W laser exposures (2-10 seconds), and conventional angioplasty was then performed. Recanalization was achieved in 33 of 36 procedures (92%), in 23 femoropopliteal (mean length, 9 cm) and three iliac total occlusions and ten femoropopliteal high-grade stenoses, with the three failures occurring in the first group. Complications included two emboli, six moderate groin hematomas, and one laser perforation. While these results are preliminary (mean follow-up, 3 months), direct laser angioplasty appears to be a useful adjunct to PTA for treating atherosclerotic arteries.