The peripheral arterial disease is increasing in prevalence as population aging in China. The diagnosis and treatment of arteriosclerosis obliterans of the lower extremities is a complex project. Based on latest literatures and our own experience, we presented a brief review of the progress in diagnosis and treatment for the disease. Aspirin and statins are important basic medical therapy recommended by latest guidelines. Vascular surgeons should be skillful enough in surgical, endovascular and hybrid techniques. We must constantly be concerned about the latest development of new endovascular techniques, such as debulking techniques, drug coated balloons and new types of stents, etc. We also need to attach importance to quality control of open surgeries as always. Hybrid techniques might have advantages in treating complex multifocal lesions and were increasingly used nowadays. Timely diagnosis, comprehensive treatment and appropriate vascular reconstruction were very important for successful management of arteriosclerosis obliterans of the lower extremities.