Objective: To review the experience in management of in-stent restenosis in lower limb arteriosclerosis obliterans (ASO) after endovascular treatment. Methods: The clinical data of 31 lower limb ASO patients (49 limbs) with post-interventional in-stent restenosis treated from June 2012 to December 2014 were analyzed retrospectively. The lesions included restricture in 37 limbs and with reocclusion in 12 limbs, and the length of lesions ranged from 8.5 to 35 cm with an average of 25.2 cm. Results: All patients received endovascular treatment. The treatment modalities included lone balloon dilation angioplasty in 35 limbs, catheter-directed thrombolysis after balloon dilation in 3 limbs, balloon dilation with additional stent implantation in 3 limbs, catheter-directed thrombolysis prior to balloon dilation in 7 limbs, and SilverHawk atherectomy in one limb. After operation, varying degrees of improvement of symptoms occurred in all cases, and the average ankle-brachial index was increased significantly compared with preoperative value (P<0.05). Twenty-eight patients were followed up for 3 to 32 months with an average of 16.2 months, during which period, restenosis recurred in 6 cases (21.4%), and all of them had a repeat balloon dilation angioplasty, and no case had limb amputation or died. Conclusion: In combination with other appropriate endovascular procedures, balloon dilation angioplasty can offer satisfactory efficacy for in-stent restenosis in lower limb arteries.