One problem of vascular angiogenesis therapy is the lack of reliable methods for evaluating blood flow in the microcirculation. We aimed to assess whether 99m Tc-macroaggregated albumin perfusion scintigraphy ( 99m Tc-MAA) predicts quantitated blood flow after therapeutic angiogenesis in patients with peripheral artery disease. Methods: Forty-six patients with peripheral artery disease were treated with bone marrow mononuclear cell implantation (BMCI). Before and 4 wk after BMCI, blood flow was evaluated via transcutaneous oxygen tension (TcPO 2 ), ankle-brachial index, intravenous 99m Tc-tetrofosmin perfusion scintigraphy ( 99m Tc-TF), and intraaortic 99m Tc-MAA. Results: Four weeks after BMCI, TcPO 2 improved significantly (20.4 ± 14.4 to 36.0 ± 20.0 mm Hg, P , 0.01), but ankle-brachial index did not (0.65 ± 0.30 to 0.76 ± 0.24, P 5 0.07). Improvement in 99m Tc-TF count (0.60 ± 0.23 to 0.77 ± 0.29 count ratio/pixel, P , 0.01) and 99m Tc-MAA count (5.21 ± 3.56 to 10.33 ± 7.18 count ratio/pixel, P 5 0.02) was observed in the foot region but not the lower limb region, using both methods. When these data were normalized by subtracting the pixel count of the untreated side, the improvements in 99m Tc-TF count (−0.04 ± 0.26 to 0.08 ± 0.32 count ratio/pixel, P 5 0.04) and 99m Tc-MAA count (1.49 ± 3.64 to 5.59 ± 4.84 count ratio/pixel, P 5 0.03) in the foot remained significant. 99m Tc-MAA indicated that the newly developed arteries were approximately 25 μm in diameter. Conclusion: BMCI induced angiogenesis in the foot, which was detected using 99m Tc-TF and 99m Tc-MAA. 99m Tc-MAA is a useful method to quantitate blood flow, estimate vascular size, and evaluate flow distribution after therapeutic angiogenesis.