With the change of diet structure and population aging, the incidence of ischemic diseases, mainly atherosclerosis obliterans (ASO), is increasing year by year in China, and has become one of the most important diseases endangering human health. Peripheral arterial occlusive disease (PAOD) mainly refers to lower extremity ASO, of which about 30% occur in the iliac artery, 70% in the femoral, N and distal arteries, and only 15% in the lower leg arteries alone. Clinical manifestations of chronic ischemia in the arteries of the lower extremities, 30% have diffuse arteriopathy, which without timely treatment will lead to limb necrosis and infection, and even amputation, which is life-threatening in severe cases. Jassinowsky’s surgery to repair damaged arteries in 1889 and Alexis Carrrel’s establishment of the principle of vascular suturing in the early 20th century laid the foundation for the development of vascular surgery. Traditional open repair (OR) procedures include thromboendarterectomy, patch angioplasty, inter-arterial or bypass diversion, and dissecting external arterial bypass diversion. For short stenosis or occlusive lesions, thromboendarterectomy, patch angioplasty, or interposition is performed; for long stenosis or occlusive lesions with good inflow and outflow tracts, arterial bypass diversion is performed, including abdominal aorta-iliac artery, abdominal aorta-femoral artery, femoral artery-N artery, and femoral artery-calf artery bypass diversion, depending on the location of the lesion; for abdominal aorta or iliac artery with extensive stenosis or occlusive lesions, arterial bypass diversion is performed. For extensive stenosis or occlusive lesions of the abdominal or iliac arteries with poor inflow tracts and existing outflow tracts, anatomic extra-axillary artery-femoral artery bypass diversion is feasible; for extensive stenosis or occlusive lesions of the unilateral iliac artery with good outflow tracts and contralateral limb arteries, anatomic suprapubic femoral artery-femoral artery bypass diversion is feasible; for diffuse lesions of lower limb arteries, venous arterialization is feasible in selective cases. Materials used for interposition or bypass include autologous materials such as the saphenous vein, cephalic vein, radial artery, and internal iliac artery, as well as synthetic materials such as Dacron and expanded polytetrafluoroethylene (ePTFE). For patients with infrapopliteal artery bypass diversion and insufficient autologous vascular material, the material and anastomotic site of ePTFE have been improved in recent years to maintain or increase the patency of the graft after small-diameter artery bypass diversion; or to form a composite vascular graft with ePTFE and autologous vessels. Due to factors such as open surgery usually requiring semi- or general anesthesia, greater trauma, intraoperative injury to collateral arteries, more intraoperative bleeding, and relatively longer operative time, the perioperative mortality and complication rates are relatively high for elderly and surgically high-risk patients. For abdominal aorta-iliac artery or femoral artery bypass diversion, because of the large diameter of the artery, as long as the outflow tract is good, a better vascular patency rate can be achieved after surgery. For revascularization of the femoral, N and below arteries, although autologous saphenous vein is the most ideal graft material, the literature reports that its 5-year patency rate is 50% to 70%; if PTFE is used as graft material, its mid-term postoperative patency rate is even lower, which is 70% if the distal anastomosis is in the suprapopliteal N artery and 12% to 54% if the distal anastomosis is in the infrapopliteal artery, and the limb salvage rate of the latter is 62 percent to 70 percent. In patients with restenosis or diversion bridge occlusion after arterial reconstruction, some patients may not be able to tolerate the procedure due to poor general condition. In patients with restenosis or bridge occlusion after arterial reconstruction, some patients may be unable to tolerate OR due to poor systemic condition or may be treated conservatively because the lesion is too extensive for reoperation. Minimally invasive endoluminal interventions have taken an important place in the treatment of PAOD compared to the surgical trauma of OR. percutaneous transluminal angioplasty (PTA) was first described by Dotter and Judkins in 1964 and is currently used for short-segment arterial stenotic lesions of the lower extremities. Its technical success rate has reached 79%-95% for short-segment arterial stenosis in the lower extremities. The results of the well-known BASIL (bypass versus angioplasty for severe ischemia of the leg) study showed that PTA and arterial bypass diversion are equivalent for survival without postoperative amputation events in patients with severe limb ischemia. The technical success rate of PTA of the superficial femoral artery is >95%, but for the femoral-N segment artery, the primary patency rate (primary patency) at 3 years after PTA ranges from 30% to 60%, depending on the length of the lesion and clinical stage. Since the intermediate and long-term patency rates can be reduced after PTA due to elastic retraction of the arterial wall, the advent of stents, especially nickel-titanium alloy (nitinol) stents, has compensated for this deficiency. Most of the nitinol stents currently used in peripheral arteries are of mesh structure, including SMART stent (Cordis, Miami Lakes, Fla), Absolute self-expanding stent (Abbott Vascular, Redwood City, Calif) and Lifestent NT stent (Edwards Lifesciences, Irvine, Calif.). The stents approved by the Food and Drug Administration (FDA) for use in the superficial femoral artery are the IntraCoil (ev3, Plymouth, Minn) and the Viabahn ePTFE-coated nitinol stent, which is more widely used, and the results of a prospective randomized controlled study showed that The results of a prospective randomized controlled study showed that the Viabahn stent had significantly better technical success rates (95% and 66%), 1-year postoperative patency rates (65% and 40%), and improvement in clinical ischemic symptoms than PTA. Subintimal angioplasty (SIA; percutaneous This technique has been promoted and applied in the past 20 years, and has achieved good clinical results. The SIA technique and special catheters have also been improved in recent years to improve the success rate of the procedure. Depending on the treatment site, the femoral, N, dorsalis pedis and posterior tibial artery accesses can be chosen for treatment. The FrontRunner XP chronic total occlusion catheter (Cordis, Inc.), which has a claw-shaped tip that allows blunt dissection, and the OutBack LTD reentry catheter (Cordis, Inc.), which facilitates subintimal reentry into the true lumen of the artery, have been developed to facilitate smooth passage of the catheter. The OutBack LTD reentry catheter (Cordis) and the Pioneer catheter (Medtronic) are available; combined with intravascular ultrasound (IVUS), the success rate of SIA procedures can be improved. 2008 Met et al. systematically reviewed 1,549 patients treated for SIA. 549 patients treated with SIA, with technical success rates ranging from 80% to 90%, with lower success rates for SIA of the pedal artery compared with the femoral artery; postoperative complication rates ranged from 8% to 17%, mostly mild. The clinical success rate at 1 year after surgery is 50% to 70%, with a primary patency rate of about 50% and a limb salvage rate of 80% to 90%. Therefore, the authors believe that SIA plays an important role in the treatment of PAOD as a temporary bypass diversion to promote wound healing and limb salvage. While interventions are widely available, the treatment of calcified plaque, infrapopliteal artery lesions and postoperative restenosis has become the driving force behind the development of interventional materials and techniques. For arterial plaques, cryoplasty and cutting balloon PTA (CB-PTA) are currently available. Cryoangioplasty combines balloon angioplasty and cryotherapy by inflating the balloon with liquid nitrous oxide to modify the plaque at the treated site, reduce vascular elasticity and induce apoptosis of local vascular smooth muscle cells (VSMCs). Scientific, Natick, Mass) has been approved by the US FDA for the treatment of PAOD. A multicenter prospective study of 102 patients with femoral and N artery lesions showed that the PolarCath System had a 94% success rate, with only 9% of patients requiring additional stenting; 70 patients were followed up for 3 years, and the clinical patency rate was maintained at 75%; another multicenter prospective study of 106 patients with calf artery lesions and severe limb ischemia showed a 97% success rate was 97% and the limb salvage rate at 1 year after surgery was 85% [21].Cochrane systematic reviews are still positive for cryoangioplasty. The dissenting opinion is that cryoangioplasty is not superior to conventional PTA in terms of long-term follow-up, and that CB-PTA reduces restenosis by reducing elastic retraction of the vessel wall and vascular injury through mechanical and biological effects. CB-PTA is more effective in the treatment of anastomotic intimal hyperplasia, lesions within saphenous vein bypass diversion bridges, and fibrous and calcified lesions than PTA, which has been approved by the FDA for cutting balloons (Boston Scientific) and AngioSculpt balloons (AngioScore, Inc. AngioScore, Inc, Fremont, Calif) for the treatment of PAOD. In a prospective nonrandomized study evaluating CB-PTA for 128 arterial lesions in the femoral artery and below, the procedural success rate was 96%, the perioperative mortality rate was 2%, and the complication rate was 9%; for femoral and N artery lesions with clinical manifestations of intermittent claudication, the primary patency rate was 82% at 1 and 2 years postoperatively; and for femoral, N, and calf artery lesions, it was 64% and 52%, limb salvage rates of 84% and 77%, and survival rates of 93% and 89%, respectively. The authors therefore concluded that distal limb artery lesions and clinical staging affect the efficacy of CB-PTA, and that long-term follow-up is necessary to assess its effectiveness. In terms of plaque resection, excimer laser atherectomy and excisional atherectomy are available for the treatment of long-segment arterial occlusive lesions. The laser was banned in the late 1980s for use in peripheral arteries because of its thermodynamic effects, but the 308 nm excimer laser has been used in Europe since 1994 for ASO of the lower extremities; its action occurs only in contact with the tissue, and each pulse removes 10 μm of tissue layer; in addition, the ultraviolet light can remove thrombus and inhibit platelet aggregation. Currently available is the Excimer Laser Plaque Rotation Catheter (ClirPath, Spectranetics Corp, Colorado Springs, Colo), a study of 411 long-segment superficial femoral artery occlusive lesions (mean length 19.4 cm) treated with a 91% procedural success rate, with only 7% of patients requiring additional stenting. Postoperative complications were low, mainly acute arterial occlusion (1%), perforation (2%) and distal artery embolism (4%). Their primary patency rate at 1 year after surgery was low, but secondary patency rate was 75%. Another study of surgically high-risk patients with combined severe lower extremity ischemia and long-segment arterial occlusive lesions (mean length 16 cm) suggested a 93% limb salvage rate at 6 months postoperatively. Transcatheter plaque removal was first proposed by Simpson in the early 1980s and was shelved until the early 1990s when a randomized controlled study of the Simpson AtheroCath System (Devices for Vascular Intervention, Redwood City, CA) suggested comparable efficacy to conventional PTA. It was shelved. Later, the modified SilverHawk device (FoxHollow Technologies, Redwood City, CA) was used in Germany with satisfactory early, intermediate, and long-term clinical outcomes, but only for highly calcified and completely occluded arterial lesions due to thrombosis. The SilverHawk device is currently available in seven sizes for femoral, N, calf, and even foot arteries, and a prospective study by Keeling et al. showed that its efficacy was related to the severity of lower extremity ischemia and arterial disease, and that postoperative patency and limb salvage rates were comparable to those of other interventions. The results for arterial lesions in the N artery and below showed primary patency rates of 67% and 60% at 1 and 2 years, respectively, and secondary patency rates of 91% and 80%. However, Chung et al. questioned the usefulness of the SilverHawk device with primary patency rates of 50%, 23%, and 10% at 3 months, 6 months, and 1 year postoperatively, respectively, and although the limb salvage rate can be maintained at 74% with reoperation, it is more expensive and has a higher rate of reoperation after surgery. In view of the complexity of PAOD and the diversity of treatment options, the Trans Atlantic Inter-Societal Consensus (TASC) classified lower extremity arterial lesions in 2000 and updated it in 2007 in order to develop the best treatment plan and to better evaluate the postoperative outcomes of different treatments. The TASC classification was updated in 2007. The TASC classification has now become the commonly adhered to standard. For aortic and iliac artery lesions, TASC A includes: (i) unilateral or bilateral common iliac artery stenosis; and (ii) unilateral or bilateral limited short-segment stenosis (<3 cm) of the external iliac artery. TASC B includes: ① short segment stenosis of the infrarenal abdominal aorta (<3 cm); ③ unilateral common iliac artery occlusion; ④ limited or multiple stenosis of the external iliac artery with a cumulative length of 3-10 cm, without involvement of the common femoral artery; ⑤ unilateral external iliac artery occlusion without involvement of the internal iliac artery and the opening of the common femoral artery. TASC C includes: (i) bilateral common iliac artery occlusion; (ii) bilateral external iliac artery stenosis of 3 to 10 cm in length without involvement of the common femoral artery; (iii) unilateral external iliac artery stenosis with lesion involvement of the common femoral artery; (iv) unilateral external iliac artery occlusion with lesion involvement of the internal iliac artery and/or common femoral artery. (4) unilateral external iliac artery occlusion with lesions involving the internal iliac artery and/or the opening of the common femoral artery; (5) unilateral external iliac artery occlusion with severe calcification and lesions involving the internal iliac artery and/or the opening of the common femoral artery. TASC D includes: (i) infrarenal abdominal aortic occlusion; (ii) diffuse lesions involving the aorta and bilateral iliac arteries; (iii) diffuse multiple stenotic lesions involving the unilateral common iliac, external iliac, and common femoral arteries; (iv) unilateral common and external iliac artery occlusion; (v) bilateral external iliac artery occlusion; and (vi) iliac artery stenosis combined with abdominal aortic aneurysm requiring These patients are more complicated and OR is the best treatment option. For lesions of the femoral and N arteries, TASC A includes: (i) limited stenosis of the superficial femoral artery ≤10 cm in length; (ii) limited occlusion of the superficial femoral artery ≤5 cm in length; intervention is preferred for these patients. artery; (3) limited or multiple arterial lesions with poor arterial conditions in the lower leg outflow tract; (4) arterial occlusion with severe calcification ≤5 cm in length; and (5) limited stenosis of the N artery. TASC C includes: (i) multiple arterial stenosis or occlusion with a cumulative length >15 cm with or without severe calcification; (ii) restenosis or occlusion after two interventional procedures. TASC D includes: (i) chronic complete occlusion of the common or superficial femoral artery >20 cm in length with lesion involvement of the N artery; (ii) chronic complete occlusion of the N artery, anterior tibial artery and proximal tibiofibular trunk. These patients can be treated with OR in selective disease. Individualized treatment of PAOD is quite important. In addition to the TASC classification, interventional treatment can be preferred for advanced age and surgical high-risk patients with anatomically appropriate composite conditions, in combination with the patient’s age and systemic condition. In addition, the success of the hybrid procedure of OR combined with intervention in complex cases has opened up new ideas for the treatment of this disease.