Objective To evaluated the efficacy of Straub Rotarex System combined with drug-coated balloon (DCB) in the treatment of lower extremity arteriosclerosis obliterans complicated with thromboembolism. Methods The clinical data of 16 elderly patients with lower limb ischemia treated with volume reduction using Straub Rotarex System combined with DCB dilatation from June 2015 to June 2018 were retrospectively analyzed. After definite diagnosis, percutaneous thrombectomy was performed for volume reduction with Straub Rotarex System, angiography was then performed, and residual stenosis was dilated with a DCB. The symptom improvement was observed, and ankle-brachial index (ABI) before and after treatment was compared, and the complications were observed. Patency and clinical efficacy were evaluated with color Doppler ultrasound at the outpatient clinic on follow-up visits during postoperative 6-12 months. SPSS statistics 22.0 was employed for data processing and t test for comparison between groups. Results Success rate of the operation was 100%. In 11 patients with resting pain, the pain was significantly relieved with significantly decreased visal analogue scale score [(2.0±0.3) vs (8.6±1.1), P<0.01]. Out of 5 patients with intermittent claudication, claudication disappeared in 3, and distances between two episodes of claudication were significantly lengthened. Postoperative ABI of the affected limb was significantly increased [(0.87±0.06) vs (0.29±0.10), t=19.89, P＜0.01]. Distal arterial embolization occurred intraoperatively in 1 patient, which was relieved after mechanical volume reduction. All patients were followed up for 6 to 12 months with a patency rate of 100%. Conclusion Rotarex thrombus system combined with DCB is safe and effective for patients with arteriosclerosis obliterans of the lower limb with thromboembolism, serving as a preferred therapeutic option for such patients.