Objective To evaluate the usefulness of ultrasonography（USG） during directional atherectomy（DA） for lower extremity artery stenosis/occlusive lesions. Methods Forty-six patients with femoropopliteal artery stenosis/occlusive lesions（＞70% stenosis, ＜5 cm in length）were included. The patients were randomly assigned into USG+DSA group（the precise location of plaque was identified by USG，and the plaque was removed under DSA subsequently）and DSA group（the plaque was removed under DSA）, each group had 23 cases. The procedural success rate on USG and DSA and the residual stenosis rate（RSR） between the two groups were compared immediately. Postoperative outcomes，such as ankle brachial index（ABI），RSR，peak systolic velocity ratio（PSVR） and primary patency rate were compared one year post operation. Results The procedural success rate was 100% on DSA in both groups. For USG evaluation，the procedural success rate of USG+DSA group was 100%，but only 39.1% for DSA group（P＜0.01）. The RSR after DA was（24.4±2.1）% and（38.7±4.6）% respectively，and the difference was statistically significant（P＜0.01）. One year after treatment，the patients in USG+DSA group showed significantly improvement in ABI, RSR and PSVR than those in DSA group（all P＜0.01）. The primary patency rate of USG+DSA group（78.3%） was higher than that of DSA group（47.8%）, and the difference was statistically significant（P=0.032）. Conclusion Intraoperative USG during DA might increase the acquirement of lumen, and is an effective and safe treatment option for short segment occlusive lesions of the femoropopliteal artery.