〔Abstract〕 Objective To investigate the clinical effect of percutaneous transluminal angioplasty and lower limb artificial vascular bypass grafting in the treatment of elderly with lower limbs arteriosclerotic occlusive disease (ASO). Methods A total of 84 elderly ASO patients treated in Nanping First Hospital Affiliated to Fujian Medical University from January 2015 to January 2017 were randomly divided into two groups, with 41 cases in each group. The control group was treated with lower limb artificial vascular bypass grafting, and the observation group was treated with percutaneous translaminal angioplasty. The results of operation,ankle brachial blood pressure index (ABI) and dorsal foot arterial hemodynamics were compared between the two groups. Results There was no statistically significant differences in 6-month patency rate, limb salvage rate, mortality and restenosis rate between the two groups (P > 0.05), but the 3-year patency rate and complication rate in the observation group were significantly lower than those in the control group, the difference was statistically significant (P < 0.05). There was no significant difference in ABI between the two groups before operation, 1 month, 3 months and 6 months after operation (P > 0.05). 1 month after surgery, there was no significant differences in the diameter, peak velocity and blood flow of dorsalis pedis artery between the two groups (P > 0.05). Conclusion Percutaneous transluminal angioplasty and lower limbs artificial blood vessel bypass grafting were used for the treatment of elderly ASO with quite recently patency rate, lumen angioplasty small trauma, low complication rate, high security and repeatability, but lower limbs artificial vascular bypass has higher long-term patency rate, clinical should choose appropriate surgical procedure on the basis of the condition of the patients.