Peripheral arterial disease (PAD) affects the arteries of the lower extremities and is responsible for claudication, ischaemic ulcerations of skin and/or gangrene because of a severe lack of blood supply to the extremity involved. If left untreated, a major amputation of the limb may be required. Three regions of arteries are responsible for carrying blood to the lower limbs: the aortoiliac segment, the femoropopliteal artery and the tibial vessels. These have various sizes and lengths and a different response to management. Their narrowing is due to atherosclerosis but aneurysms can also present. In case of a significant occlusion, the circulation may reach nearby arteries to maintain some flow beyond the obstruction. Tailored management follows cardiovascular risk factors and lifestyles, such as improving walking distance with exercise programmes in combination with pharmacological treatments to slow down the burden on the progression of atherosclerosis; ultimately, surgical interventions are imperative. Endovascular techniques such as balloon angioplasty, stenting and a combination of the two are preferred because they are minimally invasive. Ultimately, surgical interventions (thromboendarterectomy, patch angioplasty, bypass surgery or a hybrid procedure) are attempted. The role of surgical bypass in PAD patients with critical limb ischaemia deserves attention.