Diabetes is a high-risk factor for the development of lower extremity atherosclerotic occlusive disease. Diabetic lower extremity arteriopathy mainly involves the infrapopliteal artery, which is a multi-segmental diffuse lesion with severe disease and high incidence of critical lower extremity ischemia and amputation rate. The recanalization of the infrapopliteal artery has a very critical therapeutic role in diabetic critical limb ischemia. Diabetic lower extremity vasculopathy mostly involves more distal arteries with finer caliber. The traditional treatment view is that revascularization surgery is risky and the long-term patency rate is low, so drug therapy is mostly used. However, as endovascular techniques have matured, such as subendothelial angioplasty, cutting balloons, small OD low compliance high pressure balloons, drug-eluting stents, and absorbable stents, the number of patients with diabetic lower extremity vascular disease treated with endovascular therapy in the peripheral arteries has surpassed that of patients treated with coronary arteries in the United States, and most patients who previously required traditional surgical treatment can now be treated with endovascular therapy. The majority of patients who previously required traditional surgery can now be treated with endoluminal therapy. Most diabetic lower extremity arterial lesions are long-segment occlusive lesions. A foreign report studied 417 cases of 2,893 diabetic lower extremity ulcers (or gangrene) and found that 74% were infrapopliteal lesions, 66% of which were occlusive lesions, and more than 50% were long occlusive lesions >10 cm, with predominantly anterior and posterior tibial artery lesions, and 28% had total occlusion of the infrapopliteal artery, with no suitable distal outflow tract available, and the poor general condition of elderly diabetic patients There is no suitable distal outflow channel available, and elderly diabetic patients have poor systemic condition to tolerate surgery, surgical bypass surgery is a relative contraindication, and the failure rate of surgical operation is high. Endoluminal therapy is minimally invasive, safe, effective and repeatable, and is widely used in clinical practice. Moreover, even if endoluminal therapy fails, the opportunity for open surgery is still preserved, so endoluminal therapy is mostly chosen as the first treatment option for diabetic infrapopliteal arteriopathy in clinical practice. The selection of the pathway during endoluminal treatment is an important prerequisite for improving the success rate of the technique. Patients with simple infrapopliteal artery lesions can routinely choose ipsilateral paracentesis, which has the advantages of short operating distance, good maneuverability, and low incidence of severe retroperitoneal hemorrhage, but attention should be paid to the possibility of puncture into the deep femoral artery. In patients with severe obesity or combined ipsilateral iliofemoral artery lesions, contralateral retrograde puncture is a better choice. It has a high success rate of puncture, facilitates postoperative compression for hemostasis, and treats a wider range of lesions (from the iliac artery to the pedicle vessels), but reduces the maneuverability of the procedure due to the long operative distance and requires more endoluminal treatment equipment. Brachial artery access puncture is not an option due to the length of the interventional device. Retrograde puncture of the dorsalis pedis or posterior tibial artery has also been reported in the literature Balloon dilation (PTA) The treatment of diabetic infrapopliteal artery lesions is based on PTA, which was previously thought to be more effective for short segments of TASC grade A and B lesions, whereas diabetic infrapopliteal artery lesions are mostly long occlusive lesions that are challenging to treat. Previously, there were more complications with endoluminal treatment of the infrapopliteal vessels, especially the high probability of arterial entrapment, which may be due to the insufficient length of the balloon, more articulated cutting sites of the balloon when dilating long-segment lesions, and poor compliance, increasing the probability of intimal tear and entrapment formation. With the development of low-profile (2-3 mm), low-pressure, long-segment (8-12 cm, with the longest currently reaching 15 cm), high-compliance balloons (such as the Deep balloon), it has become easier to dilate the infrapopliteal artery with a wider range of expansion, even to the distal tibiofibular artery. Due to the long, compliant and low-profile balloons, it is easier to pass through the stenotic or occluded segment, which can reduce the number of dilations and the uniform force of dilatation on the vessel wall, thus reducing intimal damage, entrapment and plaque shedding, which can reduce the rate of acute occlusion and restenosis. The treatment of occlusive lesions in long segments of the lower knee has achieved good clinical results. Foreign reports of endoluminal treatment in 1188 patients with severe diabetic lower extremity ischemia showed that 93.3% had infrapopliteal arterial lesions, 83.6% underwent successful PTA, and 82.7% had at least 1 vessel to the foot opened. The average follow-up was 23 months, with a phase I 5-year patency rate of 88% and a limb preservation rate of 98.3%. Bare metal stent (BMS) Intraluminal treatment of infrapopliteal artery lesions is based on balloon dilatation and shaping, but extensive diabetic infrapopliteal artery lesions, high restenosis occlusion rate, possible elastic retraction during treatment, resulting in entrapment formation of blood flow and residual stenosis >30%, may be considered in these cases. The Xpert stent is the first self-expanding nitinol stent specifically designed for the infrapopliteal artery and is 3-6 cm long with a 4F sheath and 0.018 guidewire. It can be used for both tibiofibular artery and infrapopliteal carotid artery, which solves some shortcomings of coronary bulb-expanding stent. With the rapid advances in science and technology, the materials and perspectives of endoluminal therapy have changed dramatically, and PTA and stent implantation can rapidly restore blood supply to distal tissues, because restenosis after endoluminal therapy is a gradual process, and with the gradual formation of restenosis, the collateral circulation of the limb is gradually established vicariously, and the initial patency period may save most of the limb. Therefore, even if the vessel is re-occluded, the ulcer can still achieve long-term healing with attention to foot care, which is the clinical significance and value of endoluminal therapy.