Aim To explore the clinical effect of directional atherectomy in the treatment of superficial femoral arteriosclerosis obliterans. Methods A total of 42 patients with superficial femoral arteriosclerosis obliterans of the lower extremities were selected and randomly divided into observation group and control group, with 21 cases in each group. The observation group was treated with TurboHawk directional atherectomy system, and the control group was treated with balloon expansion and stent implantation. Collect data, observe and compare the treatment effects of the two groups. Results The postoperative clinical symptoms and ankle brachial index (ABI) improvement of the observation group were not significantly different from those of the control group (P＞0.05). The incidence of postoperative complications was lower in the observation group than that in the control group, and the difference was statistically significant (P＜0.05). Postoperative follow-up showed that the restenosis rate of the observation group was not significantly different from that of the control group (P＞0.05). Conclusions In the treatment of superficial femoral arteriosclerosis obliterans of lower extremities, directional atherectomy can achieve a patency rate similar to that of balloon dilatation and stent implantation. It is a safe, practical and effective method.