Lower extremity atherosclerotic occlusive disease is a common disease in vascular surgery and is a major cause of chronic lower extremity ischemia, the incidence of which increases with age. approximately 10% of men over 65 years of age have lower extremity atherosclerotic occlusive disease, compared to 20% of men over 75 years of age, and nearly 25% of North American hypertensive patients over 60 years of age have chronic lower extremity ischemia. Multisegmental lower extremity arterial occlusion refers to severe narrowing or obstruction of two or more segments of the main artery, and may also be referred to as multiplanar occlusion. These patients are not only older than those with single-plane arterial occlusions and have a higher proportion of severe limb ischemic symptoms, but also have more comorbidities, faster disease progression, more difficult clinical treatment, and poorer prognosis. The 1-year amputation rate of patients with severe limb ischemia without arterial reconstruction treatment is as high as 46%, requiring active clinical intervention. Currently, the treatment of multisegmental lower extremity arterial occlusion mainly includes classical arterial bypass and endovascular techniques, which have been rapidly popularized and improved in the past 30 years. This article provides a review and brief evaluation of surgical bypass and endovascular treatment of multisegmental lower extremity arterial occlusions. Arterial bypass: In patients with multisegmental lower extremity arterial occlusion, the arterial stenosis or occlusion involves multiple segments. Depending on the extent of the lesion, the corresponding arterial reconstruction is designed individually using the still open inflow and outflow tracts, and multisegmental diversions in different planes are designed to reconstruct the arterial flow. In cases where the main-iliac-femoral artery is not yet severely stenosed, adequate blood flow can be provided to the distal artery at this time, and the scope of surgery is distal to the inguinal ligament. In cases of middle or lower superficial femoral artery obstruction, femoral-N (tibial) artery bypass is an option; in cases of limited femoral-N artery occlusion, distal femoral-tibial artery bypass is feasible. When the long segment of the femoral artery is occluded, iliac-N artery bypass can be performed using the ipsilateral iliac artery. In cases of severe stenosis or occlusion of the proximal artery of the inguinal ligament, the design of the procedure includes the establishment of both an inflow and an outflow tract. The inflow tract is reconstructed by main-iliac or main-femoral artery bypass. For short-segment iliac artery stenosis, the inflow tract can be reconstructed by endarterectomy of the iliac artery. The long arm of the artificial vessel of the main-femoral artery bypass, or the common femoral artery after opening of the proximal artery, can be used as the inflow tract, followed by the designed outflow tract. If the superficial femoral artery is occluded and the N artery is patent, the bypass with the N (tibial) artery can be completed via the established main-iliac (femoral) artery bypass vessel; if the superficial femoral artery and the tibiofibular trunk are occluded but the N artery between them is still patent; if the proximal segment of the tibiofibular trunk or posterior tibial artery is open; if the middle and lower 1/3 of the anterior tibial artery in the lower leg is patent, all of the above open arterial segments can be used to create a distal anastomosis and complete femoral-N and tibial artery bypass in different planes; when using the posterior tibial artery in the medial ankle plane as an outflow tract, the caliber of the anastomosis can be enlarged and the patency rate improved by constructing a common posterior wall of the posterior tibial artery and vein. The deep femoral artery can be used as both an outflow and an inflow tract to reconstruct lower extremity blood flow. Occlusive lesions rarely occur in the deep femoral artery, and when they do, they are usually limited to 1-2 cm from its origin. It has abundant intramuscular branches and has extensive collateral circulation with the superficial femoral artery and the distal segment of the N artery. For patients who cannot tolerate open surgery, extra-anatomic bypass, i.e. axillary-femoral or femoral-femoral artery bypass, is an option to reconstruct the inflow tract. The development of artificial vascular materials has undergone an evolution of synthetic fibers, silk materials and polymers, and fabrication processes include woven, knitted, knitted and cast methods, but all of these materials and processes must have some basic performance requirements for artificial vessels (i.e., durable strength, suitable microporosity and good compliance). Polyester and polytetrafluoroethylene expanded (PTFE) artificial vessels are currently the most commonly used graft vessels, and those with diameters >6 mm have a good long-term patency rate.