Lower extremity artery disease (LEAD), commonly due to atherosclerosis, is a disease with an increasing worldwide prevalence (8.0% in Europe). Although most patients are asymptomatic, in many cases the disease can present itself as intermittent claudication or rest pain, arterial ulcers, gangrene or acute limb ischaemia (ALI). The diagnosis relies largely upon clinical presentation, but must be confirmed by objective tests such as measurement of ankle-brachial index. The two major goals in the management of patients with LEAD are: 1) treatment of ischaemic limb symptoms and limb salvage and 2) lowering the risk of complications of cardiovascular disease. While patients with intermittent claudication can usually be managed effectively with conservative therapy and lifestyle changes, patients with chronic limb-threatening ischaemia or ALI mostly require endovascular therapy, open surgery or a combination of both.