Peripheral vascular disease is part of a common, widespread, atheromatous process that affects all arterial territories – the carotid, coronary, aortic, sacral and renal arteries – although it may occur in isolation. Claudication is a prognostically important condition. It increases cardiovascular morbidity and mortality. Smoking is the single most important risk factor for peripheral vascular disease, increasing the risk in a 'dose-related' way by at least threefold. The majority of patients with claudication either are smokers or have smoked. Exercise, combined with treatment of all risk factors, is very helpful in improving symptoms of claudication. The pathology, risk factors and principles of management of peripheral arterial disease are similar to those for coronary heart disease. Patients with a variety of leg symptoms and cardiovascular risk factors should be assessed for peripheral arterial disease, because only a minority of patients with peripheral arterial disease present with typical claudication.