Abstract: [Objective] To compare the clinical effect of Tibia Transverse Transport (TTT) combined with endovascular intervention with endovascular intervention alone in the treatment of severe lower extremity arteriosclerosis obliterans (ASO). [Methods] The clinical data of 86 patients with severe ASO (Rutherford grade 5 or 6) treated in our hospital from May 2018 to January 2021 were retrospectively analyzed, and the patients were divided into the intervention + TTT group (n=46) and intervention group (n=40) according to the treatment. There were no significant differences in general data such as gender, age, and ASO grade between the two groups (P>0.05). The clinical and imaging examination results of the two groups were compared. [Results] The operations of both groups were successfully completed without serious surgical complications. All patients were followed up for 9 to 24 months, with an average of (18.5±4.7) months. Compared with the intervention group, the intervention + TTT group had higher healing rate, shorter healing time, length of hospital stay, and duration of antibiotic therapy, lower recurrence rate and minor amputation rate, fewer postoperative debridement (P<0.05). Compared with preoperatively, VAS scores of both groups were significantly lower 3 months postoperatively (P<0.05), and the VAS score of the intervention + TTT group 3 months postoperatively was lower than that of the intervention group (P<0.05). Compared with preoperatively, the angiography classification in both groups was significantly improved 3 months postoperatively (P<0.05), and the angiography classification in the intervention+TTT group was better than that in the intervention group 3 months postoperatively (P<0.05). There was no significant difference in major amputation rate and mortality between the two groups (P>0.05). [Conclusion] Endovascular intervention combined with TTT in the treatment of severe lower extremity ASO can significantly improve the healing rate, reduce the recurrence rate, healing time, length of hospital stay, duration of antiinfection therapy, postoperative debridement, and pain while without obvious surgical complications. Thus, it is an effective and safe treatment.