As a common disease in vascular surgery, interventional endoluminal treatment for lower extremity atherosclerosis, as a minimally invasive treatment, has been more and more accepted by physicians and patients in the past decade with the increasing maturity of technology and continuous improvement of materials, reflecting more obvious advantages in vascular surgery clinics. According to my personal operating experience, I have summarized some insights, and I hope they will be helpful to you. 1, the choice of puncture point The best puncture point in the common femoral artery, below the inguinal ligament, above the bifurcation point of the superficial deep femoral artery. Too high – above the inguinal ligament, it is not easy to compress and stop the bleeding, easily leading to posterior pelvic peritoneal hematoma, and those who succeed in stopping the bleeding are often complaining of femoral pain; too low – entering through the superficial femoral artery, although it is easy to compress, it is easy to cause the bifurcation of the superficial femoral artery (superficial femoral artery). The arterial puncture port is located directly below the inguinal ligament, which can be easily compressed to stop bleeding, but chronic hematoma (especially for postoperative anticoagulation) or even pseudoaneurysm can develop after decompression. Reasons: support pulling phenomenon of the inguinal ligament during limb movement, little and loose tissue under the inguinal ligament Difficulties during paralleling puncture: the guidewire enters the deep femoral artery, what should I do? Personal experience: After the guidewire enters the deep femoral artery, place a sheath into the deep femoral artery, place a short guidewire in the deep femoral artery, slowly retreat the sheath to the bifurcation of the common femoral artery, make a Roadmap, and place a Terumo 0.035J head-end superslip guidewire to enter the superficial artery without any problems. 2, the beginning of the superficial femoral artery is completely blocked at the beginning of the lesion treatment encountered when the beginning of the superficial femoral artery is completely blocked, the routine has to be from the opposite side of the femoral artery into the mountain operation, but at this time the guide wire into the lesion of the superficial femoral artery is quite difficult, how to do? (1) If we change the angle of the imaging, we can find the stump at the opening of the superficial femoral artery, which we call “plum pile”, and we can use this as a breakthrough point to pass the hard plaque at the beginning with the support of the sheath and the single-curved catheter, and choose a guidewire with a stiff tip or a super stiff guidewire. (2) If the “plum pile” cannot be found and the downward guidewire is unsuccessful, it is advisable to compare the superficial femoral artery under fluoroscopy to find the plaque shadow, and then directly puncture the superficial femoral artery in the middle and upper part of the superficial femoral artery retrograde (or cut the subcutaneous skin to expose the femoral artery under direct vision) and introduce the guidewire to the proximal end to break through the beginning of the superficial femoral artery into the common femoral artery and into the sheath of the overturned hill. The guidewire is introduced from the caudal end of the sheath on the opposite side, and the straight and rigid end of the guidewire is pulled into the superficial femoral artery, the puncture needle is withdrawn, and the guidewire is controlled and twisted into the distal end of the superficial femoral artery. Loop technique can be used for the opening of long segment arterial occlusive lesions, with the formation of a loop (Loop) with a Terumo 0.035J head-end superslip guidewire, together with a 4F or 5F single curved catheter to push the guidewire into the occluded segment, but it should be noted that the loop should not be too large, it is advisable to advance with a small loop, and when it will enter the distal femoral artery or the national artery, the hit and run technique (Hit and Run) can be used to enter successfully. True lumen, at this time the guidewire pushing is easier (resistance disappears). In the process of guidewire catheter through the long section of occlusion, sometimes the resistance will feel too large, the catheter can not follow up, at this time, it may be exchanged 3~4mm small balloon to follow up, expand and then follow up, more can enter the distal end. 4. Opening of infrapopliteal artery lesions It is easier to operate under the infrapopliteal vascular pathway map, but the premise is that the distal vessels should be visualized. At the beginning of the anterior tibial and posterior tibial arteries, a 4F single-curved catheter support with a 0.035J-tip superslip guidewire can be used to enter the occluded segment, and then a 0.014 guidewire can be exchanged to open the occluded vessel with a twist feeder. In cases of severe vascular calcification, the Invatec Diver catheter support with the Invatec 0.014 super-rigid guidewire can be used to more easily pass through the diseased segment of the vessel. The opening process of the infrapopliteal vessels is very likely to cause vasospasm, so some vascular antispasmodic drugs, such as poppyine or nitroglycerin, can be used appropriately.