Thrombo-occlusive vasculitis (TAO), also known as Buerger’s disease, is a segmental inflammatory disease involving small and medium-sized arteries that primarily affects limb vessels and causes ischemia in distal segments of the affected limbs. The pathology of TAO is characterized by extensive occlusive thrombosis of small and medium-sized arteries and veins, but the affected arteries have an intact elastic intima. This distinguishes TAO from atherosclerosis and other vasculitides. The etiology of TAO is unclear, and it is thought that the disease is caused by a combination of factors. In addition, cold, infection, vascular neuromodulation disorders, genetics and hypercoagulable states are all associated with TAO. In addition to localized lesions, intermittent claudication and resting pain may occur as the disease progresses, and ischemic ulceration and gangrene of the end of the foot (hand) may develop if the disease is not effectively controlled, leading to amputation. The rate of TAO amputation has been reported in the literature to be higher than that of patients with atherosclerosis, with 33% of patients receiving various degrees of amputation after treatment. Strict smoking cessation is an important means of preventing lesion progression and amputation and is considered the most effective treatment modality available. Pharmacological treatment includes antiplatelet and vasodilator therapy. In theory, arterial reconstruction surgery is the most effective treatment for TAO, but due to the characteristics of TAO’s own lesions, which mainly involve small and medium-sized vessels in distant segments and are widespread, most patients lack the opportunity to be treated with appropriate outflow tract loss bypass diversion. Since the 1980s, scholars at home and abroad have carried out venous arterialization surgery to treat severe ischemia of the lower extremities, and achieved good surgical results. (1) Deep group high: to establish arteriovenous flow between the external iliac, common femoral or superficial femoral artery and superficial femoral vein, for patients with occlusion of the superficial iliac-femoral artery. Meta-analysis study found that the one-year second-stage patency rate of TAO treated with this method was only 46%, but the one-year limb preservation rate could reach 71%, and most patients had healed ulcers and disappeared resting pain. Unlike atherosclerotic lesions, the inflammatory lesions in TAO are mechanized and proliferative, resulting in centripetal narrowing of the lesion and a thick and tough fibrous cap, which is sometimes difficult for the guidewire catheter to break through. In this case, a guide wire sheath can be placed under direct visualization through the vascular dissection or a local endovascular debridement can be performed to break through the fibrous cap. The guidewire is then passed through the lesion using a “collaterals” technique. Due to the slender diameter of the infrapopliteal artery and hemodynamic effects, conventional angiography may not reveal the “potential vascular lumen” between the lesioned segments. The guidewire catheter is passed down this channel into the distal normal segment. Balloon angioplasty is effective for most lesions. Calcification of TAO lesions is rare and there is no atheromatous plaque formation, so endovascular flaps rarely occur after balloon dilation. In case of elastic retraction, balloon dilation can be performed again with increased balloon pressure and dilation time. Stent implantation in TAO lesions should be avoided at all costs; stent implantation in the inflammatory lumen may further stimulate canal wall hyperplasia and accelerate progression. Other emerging therapies include spinal cord stimulators, stem cell therapy, and gene therapy, which have shown encouraging initial results but are not yet widely available. For inflammatory lesions such as TAO, treatment is specific and conventional surgical treatment is often limited. Veno-arterialization can effectively improve clinical symptoms in patients with severe limb ischemia; the development of endoluminal therapy provides a new direction for the treatment of TAO, but there is a lack of long-term follow-up results in a large sample, pending further validation of its efficacy by the results of follow-up studies.