Abstract: Objective To compare the effects of transluminal angioplasty and artery bypass grafting of lower limbs in the treatment of elderly patients with arteriosclerosis obliterans of lower extremity(ASO-LE). Methods A total of 182 elderly ASO-LE patients from January 2016 to February 2019 were randomly divided into control group(treated by artery bypass grafting of lower limbs)and observation group(treated by transluminal angioplasty), with 91 cases in each group. The hemodynamic indexes of dorsal artery of feet, ankle brachial index and complications were compared between the two groups. Results After operation, the hemodynamic indexes of dorsal artery of feet were significantly better than those before operation in both groups(P<0.05), but there were no significant differences in postoperative hemodynamic indexes between the two groups(P>0.05). The ankle brachial indexes at one month and two months after operation were significantly higher than that before operation in both groups(P<0.05), but there were no significant postoperative differences between the two groups(P>0.05). The incidence of adverse reactions in the observation group was 6.59%, which was significantly lower than 16.48% in the control group(P<0.05). Conclusion Both transluminal angioplasty and artery bypass grafting of lower limbs are safe and effective in the treatment of elderly ASO-LE patients, but the incidence of postoperative complications is lower in patients with transluminal angioplasty. In clinic, a reasonable treatment plan should be made based on comprehensive consideration of lesion location, severity of disease and complications.