Nowadays, General Practitioner (GP) have to face the progressive aging of the population. Due to that, GP have to deal with increasingly complex therapeutic decision-making in ultra-nonagenarian patients with advanced peripheral arterial disease (PAD). Extreme frailty and multiple comorbidities often lead to a conservative management approach. This study analyzes the effectiveness and sustainability of revascularization in this specific age group. The aim of the study was to  consider the impact of  minimal invasive surgery in nonagerian patients with PAD.  We have reviewed nonagenarian patients with PAD (Rutherford category 4-5-6) underwent to revascularization with minimally invasive approach between 2019 and 2024.  Preoperative evaluation of cognitive impairment and Activities of Daily Living (ADL) were performed. The primary outcome were technical success of the procedure and 30-days, 6 month and one year  mortality. The secondary outcomes were intra-hospital morbidity, limb savage and ADL manteinance.48 patients were prospectively enrolled and retrospectively analyzed. The technical success was 97.7%. 30-days mortality was 9.3%. Kaplan-Maier analysis showed an overall 6 month survival of 70%, and 1 year survival rate of 55%. Medical complications were 12.5% (4 patients with acute kidney injury; 2 patients acute coronary syndrome). 1 patient required major amputation. 79%  preserved or improved the ADL after hospitalization .During the previous years lower limb revascularizations in nonagerian patients with PAD was not considered due to its high peri-operative risk. Due to that, nonagerian patients usually underwent to major amputation. Mini- invasive techniques development allowes lower limb savege in selected nonagerian patients. The results of the study confirmed a relative low rate of 30-days mortality with an high technical success. Futhermore, results showed the maintenance of ADL and mental ability after hospitalization.In order to avoid major amputation and preserve a good autonomy and quality of life, mini-invasive revascularization should be considered in nonagenarian patients with PAD.