Atherosclerotic occlusion of the lower extremities can cause ischemia of the limbs, producing symptoms such as coldness, numbness, pallor and pain in the limbs, leading to gangrene and even life-threatening conditions. In North America, nearly 25% of hypertensive patients over the age of 60 suffer from chronic ischemia of the lower extremities. The principle of treatment for lower limb ischemia should be based on efforts to perform revascularization surgery and endovascular treatment (intervention) to restore the blood supply to the limbs. Now we report 38 cases of lower limb atherosclerotic occlusive disease treated by endovascular luminal therapy from 2005 to 2008 as follows: 1. Clinical data 1.1 General data: this year we carried out endovascular luminal therapy for lower limb arterial evolutionary occlusive disease, totaling 38 cases. There were 24 cases of male and 14 cases of female, with the age of maximum 83 years old, minimum 50, and average 70 years old. Among them, there were 18 cases of iliac artery occlusion, 22 cases of superficial femoral artery occlusion, and 8 cases of N artery occlusion. (25 cases of iliac artery, superficial femoral artery, N artery occlusion at the same time more than 2 occlusions). 1.2 Preoperative preparation: 38 patients were given a detailed preoperative history and physical examination; CTA or MRA examination was performed to further define the lesion (including the site of vascular occlusion, the length range of the lesion, etc.). Preoperative lower limb arterial stage pressure measurement and ankle/brachial ratio measurement; 3 days before the operation oral enteric-coated aspirin 100mg Bid, fasting 6 hours before the operation, prepare the necessary catheters, equipment, intraoperative medication and rescue medication. 1.3 Surgical methods: According to the location of the patient’s lesion, the presence or absence of secondary thrombosis, and the condition of the contralateral vessels, we adopted different surgical accesses. 1, contralateral femoral artery puncture: as a conventional approach, easy to operate. 2, ipsilateral femoral artery puncture: the opposite side of the lower limb blood vessels also exist stenosis or occlusion, or mild ischemic symptoms; 3, local anesthesia dissecting the femoral artery: suitable for patients with both iliac artery occlusion and superficial femoral artery or peripheral artery occlusion; interventional exploration, balloon dilatation: first of all, the scope of the site of vascular occlusion is clearly identified by imaging, and then a super-smooth guidewire and a Cobra catheter are used to pass through the occluded section of the blood vessels, and the vascular compatible balloon dilatation (balloon expansion) is carried out by a vascular compatible guidewire. Balloon dilatation (iliac artery 8~10mm, femoral artery 6~8mm, N artery 4~6mm): after dilatation, the morphology of the vessel after balloon dilatation was checked by imaging again, and if stenosis still existed, stents were implanted, and the stents were placed by imaging. If stent dilatation was unsatisfactory, balloon dilatation could be used again. After the operation, continue to take offset klyde 250mg/d and enteric azelaic acid 100mg/d. 1.4 Results: 18 cases of iliac artery were all successful, 6 cases of simple dilation, 12 cases of stenting of iliac artery, with good results. There were 22 cases of superficial femoral artery, 20 cases were successful, 8 cases of superficial femoral artery stenting. 8 cases were farther than N artery, 5 cases were successful. Interventional probing treatment failed in 5 cases, 2 cases of superficial femoral artery occlusion and 3 cases of calf vessels. Complications of which 3 cases of arterial entrapment, 4 cases of distal arterial embolism, incision to remove the embolus successfully. 1 case of intraoperative thrombosis within the stent, interventional thrombolysis was successful, the rest of the total patency. The recent success rate was 87%. The average ankle/brachial ratio (ABI) increased by 0.56 after treatment, and 12 dorsal or posterior tibial arteries were pulsating, accounting for 30%. There were no serious complications. 2, Discussion 2.1 Choice of surgical access for interventional therapy: atherosclerotic vascular disease is a systemic disease, and lesions can exist in multiple places. Therefore, the treatment should be based on the nature of the scope of the lesion, and the conditions of the contralateral vessels to choose the access route. (1) Contralateral femoral artery puncture: it is suitable for patients on the opposite side of the lesion with good conditions of the lower limb vessels and no obvious stenosis of the vessels. (2) ipsilateral femoral artery puncture: the contralateral lower limb vessel also exists stenosis or occlusion, or mild ischemic symptoms; (3) local anesthesia dissection of the femoral artery: suitable for the occlusion of the distal vascular memory retained a large number of thrombus, remove the thrombus for endoluminal treatment; (4) suitable for patients who have both the iliac artery occlusion and superficial femoral artery or peripheral artery occlusion. 2.2 Indications for endoluminal treatment of lower extremity atherosclerotic occlusion: patients between conservative treatment and surgical treatment, the main symptom is intermittent claudication, these patients often feel that diversionary surgery and expand the suspicion of the treatment, but not the treatment is unable to solve the existence of the disease. It is also suitable for patients with poor distal outflow tracts, high resistance, and poor surgical results, to improve blood flow by increasing perfusion pressure without surgical trauma, and also to open the N artery after further trial of opening through the arterial bifurcation and calf arteries, which may result in better outcomes than surgery. CTA in some of our patients showed occlusion of the superficial femoral artery, occlusion of the N artery, and opacification of the calf artery below the knee. The patient’s skin temperature below the calf was low and the skin below the ankle was florid and on the verge of necrosis, which could not be treated by diversion surgery, although only the superficial femoral artery and N artery were opened, and the calf artery was opened and failed. However, the patient’s symptoms improved significantly, resting pain disappeared, and skin temperature basically returned to normal. 2.3 Advantages of endoluminal treatment of lower limb arterial occlusive disease: 38 patients in this group had good results in the near future through endoluminal treatment, with an effective rate of 87%. 38 limbs with an average ankle/brachial ratio (ABI) improved by 0.56. And interventional probing with minimally invasive is more suitable for the elderly, frail, diabetic, cardiac patients. It can be repeated several times, and there is a chance of surgical treatment in case of treatment failure or postoperative recurrence. Moreover, for patients with poor distal outflow tract who are not suitable for diversion surgery, interventional exploration may create unexpected results.