Endovascular therapy is an important and expanding treatment option for peripheral vascular disease resulting in chronic limb ischaemia. It has the advantage of being minimally invasive with rapid patient recovery, but is limited by the requirement for sophisticated imaging systems using diagnostic radiation and expensive disposables. Recurrence of arterial disease is also more common than with conventional surgery and secondary intervention rates are high. Endovascular techniques have revolutionised the management of abdominal aortic aneurysms and some thoracic aortic aneurysms by allowing percutaneous image-guided repair; similar techniques can be used in the management of aortic trauma and dissection. Other important applications of endovascular therapy include its role in the management of acute limb ischaemia with thrombolysis and thrombectomy and in controlling haemorrhage both traumatic and non-traumatic in aetiology.