With the continuous advancement of peripheral vascular interventional techniques and devices, drug-coated balloons (DCBs) have emerged as a promising therapeutic tool, garnering significant attention in endovascular treatment for lower extremity arterial diseases. Lower extremity arteriosclerosis obliterans (LEASO) is the most common type of lower extremity arterial disease and one of the key indications for DCB technology. While DCBs have achieved remarkable progress in treating femoropopliteal lesions, their efficacy in specific lower extremity arterial conditions, such as chronic limb-threatening ischemia and in-stent restenosis, remains controversial and challenging. This article summarizes and analyzes relevant clinical studies to evaluate the application, safety, clinical efficacy, and future directions of DCBs in treating LEASO, providing deeper insights and guidance for clinical practice.