BACKGROUND: Lower extremity peripheral arterial disease (PAD) is an atherosclerotic condition affecting the peripheral vasculature, resulting in arterial stenosis or occlusion in the lower limbs. The focus is on understanding the epidemiology of this often-overlooked and debilitating disease. METHODS: Data on PAD were retrieved from the GBD 2021. To assess the burden of PAD, we measured prevalence, incidence, disability-adjusted life years (DALYs) and deaths, along with their age-standardized rates (ASRs) per 100,000 person-years. RESULTS: In 2021, the global incidence of PAD cases was 10.0 million (95% UI: 8.7 to 11.1), with an age-standardized incidence rate (ASIR) of 115.4 per 100,000 person-years (95% UI: 100.0 to 132.7). This decreased by 11.3% (95% UI: -11.2 to -11.4) from 1990 to 2021. The global disability-adjusted life years (DALYs) for PAD in 2021 totaled 1.6 million (95% UI: 1.3 to 2.1), with an age-standardized DALYs rate of 18.6 per 100,000 person-years (95% UI: 15.2 to 24.2), reflecting a reduction of 30.1% (95% UI: -31.8 to -28.3) from 1990. The ASIR increased with age, peaking among female aged 75-79 years, with 1015.8 per 100,000 person-years (95% UI: 686.9 to 1425.0) and male aged 95 + . The age-standardized DALYs rate showed minimal variation when the Sociodemographic Index was below 0.6. However, once the SDI exceeded 0.6, a reversed U-shaped relationship emerged. Behavioral and metabolic risks were identified as significant independent risk factors for PAD. By 2050, the global DALYs due to PAD are projected to reach 3.4 million (95% UI: 2.5 to 4.5), and improvements in these risks could reduce DALY counts by 36.6% (95% UI: -36.7 to -36.3). CONCLUSIONS: The burden of PAD remains heavy in 2021. The disease is disproportionately diagnosed in females and older adults, highlighting the need for increased awareness and targeted interventions in these populations.