Purpose Endovascular atherectomy devices provide a minimally invasive avenue of debulking calcified plaque that do not traditionally respond well with angioplasty and stenting. This paper presents a single centre’s experience with the Jetstream Atherectomy System (Boston Scientific) over the last two years. Methodology We retrospectively identified all cases of Jetstream atherectomy between June 2022 to April 2024. Data was collected via medical records, radiology images (intraoperative angiograms), and follow-up reviews. Data including indication, location of lesion (determined by distal extent of lesion), length of lesion, pre-treatment lumen diameter, post-atherectomy lumen diameter and post-intervention lumen diameter was recorded. Outcomes of one-year primary patency, re-intervention rate, and complications were assessed. Results A total of 57 Jetstream procedures were performed: 26 femoral, 16 popliteal, 4 crural and 1 iliac case. Of these, more than half the lesions were chronic total occlusions: 13/26 femoral, 13/16 popliteal, 4/4 crural and 1/1 iliac. Primary patency was 73.1% at one year. Average luminal gain was 24.7mm immediately post atherectomy, and 41.1mm after complete intervention (including angioplasty +/- stenting). There were a total of 10 dissections (3 femoral, 5 popliteal, 2 crural), 1 perforation, and 2 cases with significant residual clot burden. 6/57 (10.5%) cases were stented – 3 for flow-limiting dissections, 1 for perforation and 2 for residual clot burden. 2 cases had distal trashing. Conclusion The rates of primary patency in our centre is consistent with that in the literature. On analysis of lesion characteristics, longer lesions, particularly those extending to tibial vessels, have poorer outcomes with regards to complications and need for bail-out stenting. Atherectomy is an effective endovascular tool, particularly in femoral vessels and for heavily calcified or occluded vessels, to achieve reasonable luminal gain without stenting.