Peripheral arterial disease (PAD) is highly prevalent. Patients with PAD have often manifestations of atherosclerosis in other vascular territories and are at increased risk for cardiovascular events. Typical symptoms are intermittent claudication or rest pain and acral lesions in patients with advanced PAD. The majority of PAD patients is clinically asymptomatic, therefore it makes sense to look for PAD in patients with cardiovascular risk factors. The ankle brachial index (ABI = ankle/arm pressure) is regarded as an easy and cost effective method for baseline diagnostic. If ABI measurement confirms the suspected PAD, a detailed diagnostic pathway should follow in which duplex sonography plays a central role. In some cases additional radiologic imaging is necessary to complete the diagnostic or to plan therapeutic procedures.