Lower extremity atherosclerotic disease (LEAD) is one of the serious chronic diseases globally. In recent years, medical advancements have led to significant progress in LEAD treatment, yet certain challenges remain. Within the diagnostic and therapeutic process for LEAD, a shift from the traditional open surgical model to an endovascular treatment approach has yielded marked success. However, it is necessary to guard against an oversimplified diagnostic and therapeutic mindset. Personalized diagnosis and treatment should be administered based on the patient’s condition and the nature of the lesions. In real-world practice, there is often a disproportionate emphasis on revascularization procedures, overlooking comprehensive assessment and holistic management. Consequently, a recent trend has emerged, shifting the focus from mere revascularization to integrated, full-process management. This paper provides a comprehensive exposition on preoperative diagnosis and holistic assessment, the rational selection of primary treatment methods and surgical techniques, and the optimization of treatment strategies across the full life cycle, while underscoring the importance of whole-process management. It further explores the implications of this transition and its potential for future development.