Purpose Distal embolization (DE) of plaque or thrombus is a well-recognized cause of iatrogenic injury during percutaneous peripheral interventions. Several devices are available to help mitigate this and prevent potential distal ischemia. This study evaluated the incidence of DE during percutaneous intervention with the use of the Emboshield NAV-6 embolic protection system (Abbott Vascular, Abbott Park, Illinois). The relative incidence of DE during chemical thrombolysis (intra-arterial TPA), atherectomy, and treatment of in-stent restenosis (ISR) was analyzed. Material and Methods The NAV-6 was used over a 46-month period in 69 patients undergoing lower extremity arterial intervention. A database was generated through utilization of the Hi-IQ inventory management system. A retrospective analysis of this database was performed reviewing both the intervention notes stored in the EMR and the case images stored in PACS. The relative incidence of DE during chemical thrombolysis (intra-arterial TPA), atherectomy, and treatment of ISR was analyzed and compared to DE rates during procedures not involving one of the above categories. Retrieved DE was determined through identification of visible contents within the NAV-6 basket either upon visual inspection following capture and removal or inferred from identification of filling defects during DSA with the device deployed. Results Interventions were performed in 34 native vessels, 6 bypass grafts, and 29 vessels that had been stented previously. NAV-6 devices were placed immediately distal to the arterial lesion in all cases. Twenty-four were treated with intra-arterial TPA either prior to the case during overnight thrombolysis or during the case via pulse-spray thrombolysis. Of the 24 patients treated with TPA, 12 had DE retrieved through the NAV-6 (50%). Twenty patients were being treated with atherectomy (including laser, directional, and rotational) with 10 having DE retrieved through the NAV-6 (50%). Nineteen patients were being treated for ISR with or without complete thrombosis with 9 having DE retrieved through the NAV-6 (47%). Twenty-one patients had treatment not involving TPA, ISR, or atherectomy. Of those 21 patients, DE was retrieved through the NAV-6 in 4 patients (19%). 8 patients had DE despite NAV-6 use (12%) with 6 of the 8 being secondary to an over-filled filter basket. There were no cases of hemodynamically significant arterial spasm or dissection with the use of NAV-6. There was 1 device malfunction where the NAV-6 fractured during retrieval. All but 1 patient had preserved or improved runoff at the end of the case. Conclusions The overall incidence of DE during lower extremity arterial intervention was 30%. Treatment of ISR, treatment with atherectomy, or use of intra-arterial TPA was associated with an increased incidence of DE (47%, 50%, and 50%, respectively) when compared with treatment not involving one of these techniques (19%). The incidence of DE despite use of NAV-6 was 12%. These findings validate the continued use of NAV-6 during lower extremity arterial interventions particularly in the settings of ISR, atherectomy, or use of intra-arterial TPA.