This review systematically elaborates on the application of innovative devices and combined techniques for the endovascular treatment of lower extremity arterial calcified lesions, focusing on their use tailored to the depth of calcification. It details the technical principles and current application status of four atherectomy techniques (directional, rotational, orbital, and laser) targeted at intimal calcification. Furthermore, it provides an in-depth discussion on the mechanism of action and clinical evidence for intravascular lithotripsy (IVL) as a transformative technology capable of addressing deep medial layer calcification. The review also highlights the advances and value of combining intravascular imaging techniques, such as optical coherence tomography, with atherectomy for precision therapy. It shows that the application of these various innovative devices and combined techniques provides effective treatment options for lower extremity arterial calcified lesions. However, future research should focus on personalized treatment strategy selection, optimization of IVL technology, and long-term efficacy validation of new devices.
