With the increasing aging of society, the rising standard of living and changes in lifestyle, the incidence of atherosclerotic occlusive diseases is increasing year by year. Studies have shown that the number of people affected in the United States is 7 to 120 million, and the incidence of the disease in people over 70 years of age is as high as 10 – 18%. In China, although there is no exact epidemiological data, it is very common in daily clinical work. The current gold standard for the treatment of lower extremity atherosclerotic occlusive disease is reversed saphenous vein bypass. This procedure has a 1-year limb preservation rate of greater than 90%. However, bypass surgery, as an open surgical approach, has shortcomings such as high trauma and complications [5]. Gibbons reported a complication rate of 21% in 276 bypass patients, mainly incisional complications and infections, and only 45% of patients returned to normal life 6 months after surgery. The ultimate goal of minimally invasive treatment is to repair the integrity of the vascular cavity and quickly restore the blood supply to the limb with smaller incisions, less pain, and shorter hospital stays, thus preserving the affected limb. The rapid development of modern technology has made it possible to achieve this goal. In this paper, we introduce the progress and efficacy of minimally invasive treatment methods for lower extremity atherosclerosis occlusive disease. I. Percutaneous transluminal angioplasty (PTA) and endovascular stenting(S) PTA and endovascular stenting are one of the earliest and most widely used endovascular treatment techniques in the treatment of lower extremity atherosclerotic occlusive disease. PTA is generally considered suitable for short-segment stenosis and occlusive lesions in arteries such as the main iliac artery and the femoral N artery. For short-segment stenoses of large-diameter vessels, the near- and long-term patency rates of PTA treatment are high[. In contrast, for long-segment occlusive lesions, the patency rate after PTA is low. For long-segment occlusions of the iliac artery, endovascular stenting improved the long-term patency rate. The early patency rate after endovascular stenting for complete occlusion of the iliac artery is 99.2%, with a 5-year patency rate of 77% and a 10-year usual rate of 49% . Although the long-term patency rate of iliac artery PTA/endoprosthesis(S) is slightly lower compared to the 10-year patency rate of 62%-79% with main iliac artery bypass, iliac artery PTA/S is less traumatic for the patient, has fewer surgical complications, and even if the treatment fails, it does not affect the next step of vascular bypass, therefore, iliac artery PTA/S has now become the The iliac artery PTA/S is now the treatment of choice for patients with iliac artery occlusion. The patency rate of PTA/S in arteries below the inguinal plane is slightly inferior. surowiec reported results with PTA/S in 380 superficial femoral arteries: 85% first-time patency at 1 year and 52% patency at 5 years. van der Zaag and Lofberg reported similar results. Although the long-term patency rate of superficial femoral artery PTA/S has gradually increased with advances in technology and stent materials and techniques, it is still slightly inferior to the expected 5-year patency rate of 60%-90% with surgical femoral N bypass. PTA/S is less effective in arteries below the N. However, in cases that are not suitable for surgical bypass, PTA/stenting may be the preferred treatment for superficial femoral arteriosclerotic occlusive lesions. However, in patients who are not candidates for surgical bypass, PTA/S of the tibial artery may provide short-term improvement in blood flow and provide time to save the limb and promote healing of the ischemic ulcer. The rationale for cryoplasty is to prevent restenosis by inducing apoptosis and inhibiting neoplastic endothelial proliferation while simultaneously performing angioplasty (PTA) on the lesion. Fava reported treating 15 femoral N artery lesions with an early technical success rate of 93% and an angiographic first patency rate of 86% at 14 months. ), with a first patency rate of 83.2%. From the available data, the preliminary results of cryoangioplasty for lower extremity arterial occlusive disease are encouraging and provide a minimally invasive treatment for patients with lower extremity atherosclerotic occlusive disease, but its long-term efficacy needs to be evaluated in a large randomized controlled study. Laser-assisted angioplasty The principle of excimer laser ablation is to use photochemistry to cleave the molecular linkage of tissues. Its penetration layer is thin, only 50 microns, so each pulse can only ablate 10 microns. The point of action is concentrated, with no damage to the surrounding tissue and no increase in temperature. The excimer laser can ablate atherosclerotic plaques and enlarge the lumen. In 215 patients with unilateral femoral N artery occlusion treated with laser-assisted PTA or PTA alone, the average length of the occluded segment was 10.4 cm (3-14 cm), with an opening rate of 82.7% with laser-assisted PTA and 70.4% with PTA alone, and a mean follow-up of 36 m (6-52 m). ), with first and second patency rates of 21.7% and 50.8% for laser-assisted PTA and 16.3% and 35.2% for PTA alone. Steinkamp reported the results of 312 superficial femoral artery laser-assisted PTA studies: first-time, first-assisted, and repeat patency rates at 36 months were 49.2%, 76.5%, and 86.3%, respectively. The latest results of the “Laser Assisted Amgioplasty for Critical Limb Ischemia” study include 48 patients who were not candidates for surgical bypass, with a 6-month limb preservation rate of 90.5% and 86% of patients without symptoms of critical limb ischemia. Laser-assisted angioplasty opens access for subsequent treatment by ablating obstructive tissue such as thrombus and atherosclerosis in occluded arteries, and it reduces complications such as distal embolism and arterial entrapment. However, this technique still has a high incidence of arterial perforation, and the flexibility and controllability of the catheter still need to be improved, and its long-term efficacy needs to be further observed in a large sample study. The principle of subendothelial angioplasty is to artificially create a subendothelial lamina in the occluded artery through a series of intravascular manipulations, which creates a new artificial blood flow channel within the lamina and allows the blocked blood flow to continue to the lower vessel through this channel. Vraux treated 40 patients with arterial occlusion below the level of the N artery with subendothelial angioplasty, with a technical success rate of 78% and 12-month limb survival and patient mortality rates of 81% and 78%, respectively. The cumulative limb survival and limb free of severe ischemia at 36 months were 94% and 84%, respectively, and the cumulative mortality rates at 1, 2, and 3 years were 19%, 43%, and 51%, respectively. Although the first-time patency rate of subintimal angioplasty is still relatively low, the technique has shown high limb survival rates in patients with critical ischemia of the lower extremity, especially in patients with critical ischemia of the lower extremity due to arterial occlusion below the level of the N artery, for whom other treatment options are not successful, and subintimal angioplasty has shown high procedural success and limb survival rates. Therefore, for patients with critical ischemia of the lower extremity, subintimal angioplasty is a relatively safe and effective treatment. The incidence of lower extremity atherosclerosis is high, the risk is serious, and the efficacy of conventional conservative treatment is not satisfactory. In contrast, surgical treatment is highly invasive and has high complications, which is difficult for patients to bear psychologically and physiologically. In the 21st century, when the medical model is in transition to the biological, psychological and social medical model, minimally invasive medicine will show a broader prospect. As the future direction of medical development, minimally invasive medicine is particularly favored by both doctors and patients for its unique advantages such as less invasive, high safety, easy operation and faster postoperative recovery. With the continuous improvement and enrichment of various high-tech means, minimally invasive treatment methods for lower extremity atherosclerotic occlusive diseases are also increasing. In order to provide patients with the most reasonable treatment, clinicians should have an in-depth understanding and mastery of each minimally invasive technique, and each minimally invasive technique should be evaluated fairly and objectively.