Chronic lower extremity ischemia is due to peripheral vascular disease (PVD) and ranges from asymptomatic disease to critical limb ischemia. Peripheral vascular disease in the extremities may present in several ways, from claudication to rest pain and stenotic vessels to total occlusion. Diabetes and smoking are the highest risk factors for PVD. Patients with peripheral vascular disease often have comorbid vascular disease elsewhere (i.e., coronary and renal arteries). Oftentimes the examiners here will be testing indications for surgery and nonoperative management of PVD. Look for lesions at major branching points. Treatment ranges from medical management to open surgery based on the patient’s disease burden.