Peripheral artery disease (PAD) commonly affects multiple and bilateral vessels in the lower extremities. The goal of revascularization in patients with disabling intermittent claudication (IC) is to increase available blood flow to the symptomatic muscle beds to relieve pain and improve exercise tolerance and physical function. Advances in endovascular technology and their dissemination have led to growing rates of intervention for IC. Selecting the optimal revascularization strategy for the individual patient with IC involves a careful assessment of symptom severity, laterality, anatomic pattern of disease, and personal goals. In patients with multi-level or bilateral disease, a staged approach is frequently employed. Common exceptions include interventions for bilateral aorto-iliac disease or hybrid approaches combining iliac and/or common femoral artery treatment with femoro-popliteal intervention. In each case, the risk-benefit analysis should include an assessment of anatomic durability and the tradeoffs of downstream secondary interventions. Treatment of all in-line disease is neither necessary nor, in some cases, appropriate to achieve the desired functional goals. A staged strategy complemented by optimal medical therapy, exercise, and lifestyle modification often provides an excellent outcome for patients with multi-level and/or bilateral disease. There is little evidence to support preferred algorithms for revascularization in IC; thus, emphasis should be placed on incorporating the patient into the decision process through education, understanding of achievable goals, and a holistic long-term approach to PAD care.