Lower extremity atherosclerotic occlusive disease (ASO) is a common peripheral arterial disease with a steadily increasing global incidence. As a key pathological change in ASO, arterial calcification plays a crucial role in its pathogenesis, diagnostic evaluation, treatment strategies, and prognosis. In recent years, with the continuous advancement of imaging and biomarker detection technologies, quantitative assessment and clinical research on arterial calcification have deepened, providing new perspectives for individualized diagnosis and treatment. This review begins with the pathophysiological mechanisms of arterial calcification and systematically summarizes current detection methods, its impact on endovascular therapy, and recent progress in prognostic evaluation, aiming to provide theoretical support and practical reference for precision treatment of ASO patients.