• (MAE) Major adverse events Rate [ Time Frame: 6, 12 and 24 months ]
  Defined as clinically driven target lesion revascularization (TLR), any death and any unplanned major amputation of the index limb.
• Technical success [ Time Frame: Day 1 ]
  defined as the ability to cross and treat the target lesion with the Rotarex®S Catheter to achieve residual angiographic stenosis no greater than 50% directly after Rotarex®S Catheter use.
• Freedom of Target Lesion Revascularization (TLR) [ Time Frame: 12 Months ]
  Freedom of Target Lesion Revascularization (TLR)
• Freedom of Target Vessel Revascularization (TVR) [ Time Frame: 1, 6, 12 and 24 Months ]
  Freedom of Target Vessel Revascularization (TVR)
• Incidence of clinically significant Rotarex®S Catheter -related distal embolization requiring further treatment with pharmacologic or mechanical devices (except treating with intravascular nipride or nitroglycerin). [ Time Frame: From start to end of procedure ]
  Rotarex®S Catheter -related distal embolization requiring further treatment with pharmacologic or mechanical devices (except treating with intravascular nipride or nitroglycerin).
• Incidence of Rotarex®S Catheter -related perforations. [ Time Frame: From start to end of procedure ]
  Rotarex®S Catheter -related perforations.
• Clinical success [ Time Frame: 1, 6, 12 and 24 months ]
  Defined as clinical category improvement in the Rutherford Class at 1, 6, 12 and 24 months with reference to the baseline value.
• Hemodynamic success [ Time Frame: 30 days ]
  Defined as a > 0.15 improvement in ABI (ankle-brachial index) at 30 days with reference to the baseline value.
• Primary patency at 1, 6, 12 and 24 months. [ Time Frame: 1, 6, 12 and 24 months ]
  Defined as freedom from >50% restenosis as indicated by an independently verified duplex ultrasound peak systolic velocity ratio (PSVR) < 2.5 in the target vessel with no clinically driven target lesion revascularization (TLR).
• Walking improvement at 1, 6, 12 and 24 months assessed by Vascu Quality of Life Questionnaire (VQ-6). [ Time Frame: 1, 6, 12 and 24 months ]
  Walking improvement assessed by Vascu Quality of Life Questionnaire (VQ-6)
• Quality of Life improvement at 1, 6, 12 and 24 months assessed by Questionnaire. (EQ5D-3L) [ Time Frame: 1, 6, 12 and 24 months ]
  Improvement of quality of life assessed by Questionnaire (EQ5D-3L)
• Duration of hospital stay for index procedure [days]. [ Time Frame: Duration of hospital stay, up to 12 weeks ]
  Number of day from admission to discharge from hospital.
• Duration of ICU stay for index procedure [days]. [ Time Frame: Duration of ICU stay, up to 12 weeks ]
  Number of day from admission to discharge from intensive care unit.
• Procedural success [ Time Frame: From start to end of procedure ]
  Successful revascularization of target lesion defined as ≤30% residual angiographic diameter stenosis following Rotarex®S Catheter treatment ± adjunctive treatment.
• Successful use of Arterio Venous-Fistula as dialysis access, defined as successful use of the fistula for dialysis on at least one occasion. [ Time Frame: Up to 14 days ]
  Only for patient subject to Arterio Venous-Fistula treatment with Rotarex®S Catheter.
• Number of patients whose hemodialysis is efficient at 1, 6, 12 and 24 months without needing further treatment of the stenotic site after Rotarex®S treatment of the Arterio Venous-Fistula. [ Time Frame: 1, 6, 12 and 24 months ]
  Only for patient subject to Arterio Venous-Fistula treatment with Rotarex®S Catheter.
• (SAEs) Serious Adverse events Rate [ Time Frame: 6, 12 and 24 months ]
  SAEs as defined per ISO 14155.
• Procedure-related Adverse events Rate [ Time Frame: 6, 12 and 24 months ]
  Procedure-related AEs as defined per ISO 14155.
• (ADEs) Adverse device effects Rate [ Time Frame: 6, 12 and 24 months ]
  Adverse device effects (ADEs) as defined per ISO 14155.

Inclusion Criteria:

1. Patient is ≥18 years old at the time of consent.
2. Subject has provided written informed consent prior to participation in the study, understands the purpose of this study and agrees to comply with all protocol-specified examinations and follow-up appointments.
3. Female patients of childbearing potential have negative pregnancy test ≤7 days before the procedure.
4. Documented symptomatic peripheral arterial disease.
5. Acute, subacute and chronic (sub-) occlusion, with ≥ 90% stenosis in native arteries and/or stents / stent grafts and/or Bypass grafts and/or AV Fistula (Dialysis access).
6. De novo or re-occluded lesion.
7. Vessel and/or stent diameter within treatable range as per Instruction For Use.

8. Occlusion crossed intraluminally by a guidewire.

   For patients requiring lower limb intervention:

9. Patient presenting with a category from 2 to 5 according to the Rutherford classification for chronic limb ischemia or a category from I to IIb according to the Rutherford classification for acute limb ischemia.

Exclusion Criteria:

1. Life expectancy < 2 years.
2. Pregnant or nursing a child.
3. Contraindication, intolerance, or allergy to contrast media that, in the opinion of the investigator, cannot be adequately pre-medicated.
4. Myocardial infarction within 60 days prior to index procedure.
5. History of severe trauma and/or sepsis within 60 days prior to index procedure.
6. Cerebrovascular accident (CVA) or Transient Ischemic Attack (TIA) within 60 days prior to index procedure.
7. Evidence of intracranial or gastrointestinal bleeding or intracranial aneurysm within 90 days prior to index procedure.
8. Abnormal electrocardiogram or blood test results and/or any other factor that would increase risk by participating in the study in the opinion of the investigator.
9. Target lesion not crossed with guidewire or extraluminal guidewire crossing (even if in short segments only).
10. Additional lesion that is located >3cm away from the target lesion
11. Treatment plan of the target lesion includes laser, brachytherapy, or atherectomy other than the Rotarex®S Catheter.
12. Patient is currently participating in another investigational drug or device study that has not reached the primary endpoint.
13. Patients contraindicated for antiplatelet therapy, anticoagulants or thrombolytics.
14. Patients with uncorrected bleeding disorders.
15. Thrombophlebitis or deep vein thrombosis within the past 30 days.