Peripheral arterial disease (PAD) is characterized by increased incidence and prevalence, both of which increasing with age (prevalence about 19% above 70 years versus 2.5% below 60 years); PAD is strongly dependent upon smoking and diabetes mellitus as cardiovascular risk factors. Patients suffering from peripheral arterial disease are patients at high cardiovascular risk, albeit symptomatic patients (intermittent claudication) or asymptomatic patients (added risk for cardiovascular events 4-5%/year); these risks increase in patients needing revascularization surgery (6%), mainly due to association of coronary or cerebro-vascular disease. A fair assessment of preoperative risks (risks depending on patient background, type of surgery, emergency status of surgical procedure) aids in the optimal management of such patient both at the time of performing the procedure and in the long-term patient management. This is why new parameters are required for assessing the risk and identifying a subgroup of patients at high-risk for acute cardiovascular events and for customizing the diagnostic and therapeutic algorithms for such patients.