For the first time, the European Society of Cardiology has edited guidelines on the treatment of peripheral artery disease. With respect to the treatment of lower extremity disease, the endovascular approach is recommended in the majority of cases, independently of clinical presentation (claudication or critical limb ischemia) and of lesion complexity (TASC II A-B-C). For very complex lesions (TASC II D) surgery remains preferred. However, the guidelines state that in experienced centers even those lesions may be treated by endovascular means, especially in patients at high risk for surgery.