Background: The aim of this study was to compare drug eluting balloon (DEB) angioplasty with and without mechanical thrombectomy system in patients with chronic (> 6 months) femoropopliteal occlusions. Method: We retrospectively identified patients from May 2012 to September 2014 at our clinic with severely diseased femoropopliteal arteries treated by endovascular approach with or without adjunctive thrombectomy system. All patients had ankle-brachial index (ABI) measured before and after the intervention, and regular clinical follow-up with Doppler ultrasonography performed at 1 month, 6 months and 1 year. Patients underwent peripheral angiography if needed. Results: Mechanical thrombectomy system (MTS + DEB)was used in 33 patients (31 enrolled 2 patientswere lost to follow-up, mean lesion length 149.7mm 82.69). The remaining 33 patientswere treated withoutMTS (31 enrolled 2 patients were lost to follow-up DEB N = 31 mean lesion length 157.3mm92.90). There were 5 restenosis in the MTS + DEB group (83.3% patency rate) and 5 restenosis in the DEB group (82.8% patency rate) at 1 year. The technical success rate was 93.5% in both groups. A statistically significant increase in the ABI (MTS + DEB before 0.47 0.11 vs. after 0.92 0.11 p < 0.01 DEB before 0.47 0.11 vs. after 0.90 0.14 p < 0.01) and improvement in Rutherford staging (p < 0.01) was noted in both groups following intervention. Conclusions: DEB angioplasty is effective in the treatment of chronic total femoropopliteal occlusions. Combining DEB angioplasty and thrombectomy system does not appear to improve outcomes for treatment of chronic femoropopliteal occlusions.