Lower extremity arteriosclerosis obliterans (ASO) is a common and frequently-occurring disease among middle-aged and elderly adults, and its incidence has been on the rise over the years. Because of the advantages of being minimally invasive, safe and effective as well as quick recovery, endovascular therapy has become the preferred treatment option for ASO. At present, the introduction of the endovascular debulking namely the concept of “leave nothing behind” and the rapid update of endovascular instruments have provided a new development direction for endovascular therapy of ASO. Percutaneous transluminal angioplasty represented by the application of drug-coated balloon (DCB) and the new emerging endovascular debulking technology has been the forefront of the development of ASO in recent years. Debulking atherectomy (DA), as an important technique of intravascular volume reduction of ASO, combined with DCB therapy can continuously inhibit intimal hyperplasia by using anti-proliferative drugs on the basis of expanding the lumen volume, and thereby maximally increase the rates of mid- and long-term lumen patency. The combined use of the two techniques currently may be the optimal treatment strategy for ASO of lower limbs, and it will also be one of the main measures with the greatest development potential in the next decade. Here, the authors, based on the characteristics of DA technique and DCB, address the application status and research progress of the combined treatment of the two techniques for ASO in lower limbs, such as femoropopliteal arteriosclerosis obliterans, below-the-knee atherosclerotic disease, arterial trans-articular disease of the lower limb and in-stent restenosis.