A 68-year-old man with a history of superior mesenteric arterial thromboembolism due to chronic atrial fibrillation had experienced intermittent claudication (IC) of his left leg for 3 years. Computed tomography angiography showed focal occlusive lesions in the left distal popliteal artery and proximal segments of the infrapopliteal arteries. Endarterectomy was performed for these localized arterial lesions, and a drastic symptomatic improvement of IC after revascularization was achieved. The endarterectomized segments remained patent for 4 years after the surgery. Endarterectomy could be a useful alternative to bypass surgery and endovascular therapy for the treatment of localized infragenicular arterial lesions.