Given the aging population, the number of patients at risk for peripheral arterial disease and critical limb ischemia will increase in the upcoming decade. Using a focused history and physical examination, along with a combination of noninvasive physiologic testing and noninvasive and invasive imaging modalities, one can accurately assess the location and physiologic effect of peripheral arterial disease. This assessment then allows the selection of the most appropriate treatment option for each patient. Treatment options may include exercise and risk-factor modification, amputation, and endovascular or surgical revascularization or a combination of both.