The incidence of atherosclerotic occlusive diseases is increasing year by year with the aging of society, the rising standard of living of the people and changes in their lifestyles. Studies have shown that the number of patients in the United States reaches 7 million to 120 million, and the incidence rate of elderly people over 70 years of age is as high as 10~18%. In China, although there is no exact epidemiological data, but it is very common in daily clinical work. The current gold standard for the treatment of lower extremity atherosclerotic occlusive disease is reversal saphenous vein bypass. The 1-year limb preservation rate for this procedure is higher than 90%. However, as an open surgical procedure, bypass surgery has the shortcomings of high trauma and many complications, etc. Gibbons reported that the complication rate of 276 patients with bypass surgery was 21%, which was mainly incision complications and infection, and only 45% of the patients recovered their normal life at 6 months after the surgery. In recent years, minimally invasive treatment technology for lower limb atherosclerosis occlusive disease has been gradually adopted by the clinic for its minimally invasive, practical and many other superiorities. The ultimate goal of minimally invasive treatment is to repair the integrity of the vascular lumen and restore the blood supply of the limb quickly with smaller incisions, less pain and shorter hospitalization time, so as to preserve the affected limb. The rapid development of modern technology has made it possible to realize this goal. This paper introduces the progress and efficacy of minimally invasive treatment of lower extremity atherosclerotic occlusive disease 1, percutaneous transluminal angioplasty (PTA) and endovascular stenting (S) PTA and endovascular stenting is the treatment of lower extremity atherosclerotic occlusive disease is the earliest and one of the most widely used endoluminal treatment techniques. PTA is generally considered to be suitable for short-segment stenotic and occlusive lesions in arteries such as the aortoiliac artery and femoral N artery. For short-segment stenosis of large-diameter vessels, the near- and long-term patency rates of PTA treatment are high. For long-segment occlusive lesions, the patency rate after PTA was low. For long-segment occlusions of the iliac arteries, endovascular stenting improved the long-term patency rate. Early patency after endovascular stenting for complete occlusion of the iliac arteries is up to 99.2%, with a 5-year patency rate of 77% and a usual 10-year rate of 49% . Although the long-term patency rate of iliac artery PTA/endoprostenting(S) is slightly lower compared with the 10-year patency rate of 62%-79% of aortoiliac artery bypass, iliac artery PTA/S is less traumatic to the patient, has fewer surgical complications, and even if the treatment fails, it will not have an impact on the next step of vascular bypass, so iliac artery PTA/S is now becoming a preferred treatment method for patients with iliac artery occlusion. Treatment of choice. The patency rate of PTA/S in arteries below the inguinal plane is slightly less favorable. surowiec reported results of 380 superficial femoral arteries treated with PTA/S: first-time patency at 1 year was 85%, and the 5-year patency rate was 52%. van der Zaag and Lofberg reported similar results. Although the long-term patency rate of superficial femoral artery PTA/S is gradually increasing with advances in technology and stent materials and techniques, it still pales in comparison with the expected 5-year patency rate of 60% to 90% for surgical femoral N bypass. However, due to the minimally invasive advantage, most scholars now believe that PTA/stenting can be the first choice of treatment for superficial femoral atherosclerotic occlusive lesions in cases of advanced age and risk of surgical treatment, and that the efficacy of PTA/S in arteries below the N artery is poorer. However, for patients who are not suitable for surgical bypass, tibial artery PTA/S can provide short-term improvement in blood flow and provide time for limb salvage, which promotes the healing of ischemic ulcers. 2.Cryoplasty The theoretical basis of cryoplasty is that while angioplasty (PTA) is performed on the diseased vessel, cryogenic freezing of the lesion is performed to induce apoptosis and inhibit neoplastic endothelial proliferation, thus preventing the occurrence of restenosis.Brambillal reported that 129 patients were treated with Polar CathTM cryoplasty device, which was used for the treatment of ischemic ulcers. Brambillal reported that the Polar CathTM cryoplasty device was used to treat 129 patients with atherosclerotic occlusive disease of the lower extremities (iliac artery in 18%, superficial femoral artery in 82%), and 65% of the patients were asymptomatic at 6 months after the procedure.Fava reported that the treatment of femoral N-artery lesions in 15 patients had a 93% success rate of the early technique, and the rate of first-time patency on angiography at 14 months was 86%.Laird reported that the treatment of femoral N-artery lesions in 70 patients was successful, and the first-time patency rate was 86%. Laird reported treating femoral N artery lesions in 70 patients with a first patency rate of 83.2% at 11-41m (mean 31m) of follow-up. According to the existing information, the preliminary results of cryoangioplasty for lower extremity arterial occlusive disease are encouraging, providing a minimally invasive treatment for patients with lower extremity atherosclerotic occlusive disease, but its long-term efficacy needs to be evaluated by a large sample of randomized controlled studies. 3.Laser-assisted angioplasty (Laser-assisted angioplasty) The ablation principle of excimer laser is to use photochemistry to crack the molecular connection of tissues. Its penetrating layer is thin, only 50 micrometers, so each pulse can only ablate 10 micrometers. The point of action is concentrated and there is no damage to the surrounding tissue and no increase in temperature. Excimer laser can ablate atherosclerotic plaque and enlarge the lumen. Combined with PTA, it can help to open long occlusive lesions.Steinkamp[26] reported that 215 patients with unilateral femoral N-artery occlusion were treated with laser-assisted PTA or PTA alone, and the average length of occluded segments was 10.4 cm (3-14 cm), with the opening rate of laser-assisted PTA being 82.7%, and the opening rate of PTA alone being 70.4%, with an average follow-up of 36m (6-52m). (6-52m), the first-time and re-opening rates were 21.7% and 50.8% for laser-assisted PTA, and the first-time and re-opening rates were 16.3% and 35.2% for PTA alone.Steinkamp[27] reported the results of a study of laser-assisted PTA for the superficial femoral artery in 312 cases: the first-time, first-time-assisted, and re-opening rates were 49.2%, 76.5%, and 86.3%, respectively, at 36 months. and 86.3%, respectively. The latest results of the “Laser Assisted Amgioplasty for Critical Limb Ischemia” study: including 48 patients who were not candidates for surgical bypass, the 6-month limb preservation rate was 90.5%, and 86% of the patients had no symptoms of critical limb ischemia. Laser-assisted angioplasty opens the way for subsequent treatment by ablating obstructive tissues such as thrombus and atherosclerosis in the occluded artery, and it reduces complications such as distal embolization 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 large sample studies. 4, subendocardial angioplasty The principle of subendocardial angioplasty is through a series of intravascular operations, artificially caused in the occluded artery subendocardial sandwich, in the sandwich to form a new artificial blood flow channel, so that the blocked blood flow through this channel to continue to the lower section of the vessel.Treiman reported that the application of subendocardial angioplasty treatment of 29 cases of femoral N arterial occlusion patients, the average follow-up for 38 months(28- Treiman reported treating 29 patients with occlusion of the femoral N artery with a mean follow-up of 38 months (28-54 months) and 1-, 2-, 3-, and 4-year patency rates of 85%, 64%, 18%, and 9%, respectively.Vraux applied subendovascular angioplasty to 40 patients with occlusion of the arteries below the level of the N artery, and the technique had a success rate of 78%, with a limb survival rate of 81% and patient mortality rate of 78% at 12 months, respectively.Ingle reported treating 67 patients (71 lower limbs) with subendovascular angioplasty. Ingle reported that subendovascular angioplasty was used to treat 67 patients (71 lower extremities) with severe ischemia of the lower extremities due to arterial occlusion below the level of the N artery, with technical and clinical success rates of 86% and 80%, respectively. the cumulative limb survival and limb freedom from 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 subendovascular angioplasty is still relatively low, the technique has a high limb survival rate in patients with critical ischemia of the lower extremities, especially in patients with critical ischemia of the lower extremities due to occlusion of arteries below the level of the N artery, where all other therapeutic options have failed, and subendovascular angioplasty has shown a high procedural success rate and limb survival rate. Therefore, for patients with critical ischemia of the lower extremities, subendovascular angioplasty is a relatively safe and effective treatment. Atherosclerotic occlusive disease of the lower limb has a high incidence and serious harm, and conventional conservative treatment is not ideal. Surgical treatment is traumatic and has high complications, which is difficult for patients to bear psychologically and physiologically. In the 21st century, minimally invasive medicine will show a broader prospect in the transition of medical model to biological, psychological and social medical model. As the future direction of medical development, minimally invasive medicine is favored by both doctors and patients for its unique advantages such as less traumatic, high safety, easy operation, and faster postoperative recovery. With the continuous improvement and enrichment of various high-tech means, the number of minimally invasive treatments for lower limb atherosclerotic occlusive disease is also increasing. In order to enable patients to receive the most reasonable treatments, it is necessary that clinicians should have an in-depth understanding and mastery of each minimally invasive technique, and each minimally invasive technique should be evaluated in a fair and objective manner.