The prevalence of peripheral arterial disease (PAD) continues to increase, with recent data suggesting that almost 30% of patients in at-risk populations have PAD. Interest in the management of PAD has increased, partly secondary to the technologic advancement of devices and procedures capable of treating a wide array of vascular disorders via endoluminal techniques. A thorough clinical evaluation and accurate noninvasive testing remain the cornerstones of successful patient management and will promote improved outcomes through better patient selection. The utility of physiologic tests for determination of the presence and severity of PAD and more sophisticated imaging studies will allow the cardiovascular specialist to make appropriate decisions about management options. The currently accepted methods for determining the presence of PAD include a historic review of patient symptoms and atherosclerotic risk factors, physical examination, and the appropriate use of noninvasive modalities and X-ray digital subtraction angiography.