Lower extremity peripheral arterial disease (PAD) affects approximately 10% of the American population, with 30% to 40% of these patients presenting with claudication symptoms. The prevalence of PAD increases with age and the number of vascular risk factors. More importantly, it is a marker of atherosclerotic disease burden, and is associated with increased mortality from cardiovascular and cerebrovascular causes. There have been recent advances in noninvasive imaging, endovascular approaches for revascularization, and aggressive risk factor management for prevention of cardiac and cerebrovascular complications in PAD. There is now a trend toward aggressive risk factor modification and endovascular revascularization for most patients, with surgical interventions reserved for certain situations only. In the present article, a systematic review is presented, focusing on the key aspects of the disease epidemiology, presentation, natural history, diagnosis and available management options.