The prevalence of peripheral artery disease is substantially higher in patients on chronic hemodialysis than in the general population. The presence of calcified lesions characteristic of hemodialysis patients has an adverse influence on the initial success and long-term outcomes of both surgical bypass and endovascular therapy. Although the selection of revascularization strategy depends on whether an autologous vein is available and if the patient has a life expectancy of at least two years, it is difficult to predict the life expectancy in a real-world clinical situation. Endovascular therapy may be appropriate for many hemodialysis patients with poor general condition because of the high risk of perioperative complications and the poor long-term prognosis. Deciding which treatment option is more appropriate should be done on a case-by-case basis, especially in hemodialysis patients with critical limb ischemia.