Lower limb atherosclerosis-occlusive disease is a common peripheral vascular disease, and endoluminal treatment is gradually replacing traditional vascular surgery as the treatment of choice due to its advantages of less trauma, repeatability and high limb preservation rate. PTA treatment of infrapopliteal artery mainly uses a special balloon to dilate the artery of the affected limb, reconstruct blood flow to the distal tissues of the lower limb, rapidly relieve the resting pain caused by ischemia, promote the healing of ulcers, and thus achieve the goal of limb preservation. Patients with infrapopliteal atherosclerosis are often elderly and have multiple underlying diseases such as diabetes, hypertension and coronary artery disease, and PTA treatment can greatly reduce the risk of cardiovascular accidents. Patients with lower extremity atherosclerotic occlusive disease are often of advanced age and have multiple comorbidities and systemic underlying diseases, so perioperative management is crucial. Secondly, lower extremity atherosclerosis ischemia is a prominent manifestation of systemic vascular disease, so a comprehensive preoperative examination and adequate evaluation are particularly important, and cardiovascular and cerebrovascular accidental death often occurs after successful surgery. For patients with renal insufficiency, intraoperative use of isotonic contrast agents such as MicroVision Pike is used as much as possible to reduce the amount of contrast agent used. Intraoperative and postoperative hydration can be appropriate, and sometimes the contrast agent can be diluted by 40% to 50% to reduce the damage of contrast agent on renal function. For patients with systemic multiple underlying diseases, vital signs should be closely monitored after surgery. All patients in this group underwent endoluminal therapy under the premise of active control of underlying diseases, so there were no perioperative deaths and no postoperative renal failure, heart failure or contrast nephropathy, and the incidence of perioperative complications in this group was low at 5.0%. Key points of infrapopliteal artery endoluminal treatment Infrapopliteal artery occlusions mostly involve multiple arteries, and distal limb ischemia is more serious, often leading to CLI, with a high amputation rate (40%) and mortality rate (20%). PTA endoluminal treatment, however, is more advantageous for lesions with poor distal outflow tract conditions and multisegmental lesions, especially long segmental lesions. The key to interventional endoluminal angioplasty is the smooth passage of the guidewire through the occluded segment of the artery, which requires skilled cooperation of the guidewire catheter. The successful implementation of PTA for infrapopliteal arteriosclerosis occlusion should pay attention to: (i) Selecting a suitable puncture approach, assessing the local condition of the penetrating artery according to the preoperative CTA or MRA examination results, and preferably choosing a paralleling puncture for infrapopliteal arteriosclerosis occlusion, or puncturing the contralateral artery if the condition of the affected artery is checked. ②, retrograde puncture of the pedal vessels under the roadway through the stenotic or occluded segment can be considered when the guidewire is unable to pass through the long segment of occlusion and the distal vessels are in good condition, and the stenotic or occluded tibial artery can be opened as much as possible during the operation. For lesions with difficulty in opening the long segment of occlusion, subintimal agioplasty SIA can be attempted, and this technique was performed in some of our patients. Faglia et al. believe that amputation can be avoided by keeping any of the tibial arteries straight to the foot open, while amputation cannot be avoided in some patients by keeping only the peroneal artery open; ③, there are DEEP balloons, SAVVY balloons, ReeKross balloons and Bantam balloons, which have their own advantages and disadvantages. The balloon dilation time should be extended as long as the patient can tolerate, in order to obtain the best angioplasty at one time, and analgesic drugs (such as diazoxide) can be considered before surgery to reduce intraoperative pain; in case of entrapment, high pressure balloon dilation for a long time can be considered for the plastic line. For vascular lesions at the bifurcation, it is best to adopt a double guidewire technique to avoid entrapment of branch vessels and angiogenesis. (④) Intraluminal surgery should not be pursued too much for imaging perfection, which can easily lead to add to the problem. ⑤ Although Andrew et al. showed that the 1-year patency rate of infrapopliteal stents was 100%, there is still a great controversy regarding the placement of stents in infrapopliteal vessels. No stents were placed in this group of patients. Postoperative restenosis control There is no denying the high restenosis rate of infrapopliteal endoplasty, with a 1-year restenosis rate of 30% for stenotic lesions and up to 80% for occlusive lesions. Repeated PTA therapy is the advantage of endoluminal therapy. In contrast, drug-eluting balloons may reduce the occurrence of restenosis in infrapopliteal atherosclerotic occlusive disease, and its long-term efficacy needs to be further investigated. While most scholars have focused on the near- and long-term patency rates of infrapopliteal arterioplasty, the ultimate goal of treatment of infrapopliteal arteriopathy in atherosclerotic occlusive disease is to improve ischemic symptoms to improve quality of life, promote ulcer wound healing, and reduce the amputation plane and/or amputation rate, rather than to maintain patency. Long-term patency of the blood supply to the foot is usually required only in infected or large wounds requiring extensive wound debridement. Restenosis after PTA of the infrapopliteal artery is a gradual process in which the collateral circulation of the limb is gradually compensated, which is the clinical significance and value of PTA of the infrapopliteal artery, especially in diabetic patients with little collateral circulation in the lower limb is more important to buy time therapeutically. In conclusion, PTA can effectively relieve the symptoms of lower limb distal ischemia caused by infrapopliteal atherosclerosis occlusion, reduce the amputation rate, improve the quality of life of patients, with satisfactory recent efficacy, and can be used as the preferred treatment option for infrapopliteal atherosclerosis occlusion.