The European Society for Vascular Surgery (ESVS) has released the 2023 edition of the "Clinical Practice Guidelines on Antithrombotic Therapy for Vascular Diseases" for the first time. The guidelines provide a detailed introduction and updates on the antithrombotic strategies for atherosclerotic lower extremity arterial disease (LEAD), along with 21 specific recommendations. The prevalence of LEAD and its associated public health costs continue to rise, making antithrombotic therapy a cornerstone in treating LEAD patients. Therefore, the authors interpret the antithrombotic strategies for LEAD, focusing on evidence-based medicine from the guidelines and considering clinical practice, hoping to assist healthcare professionals in better understanding and adhering to the guidelines.