The generally accepted first-line treatment in patients with intermittent claudication is risk factor modification, medical treatment and exercise training. In an era of reduced resources, the benefit of any further invasive intervention must be weighted against best conservative therapy for patients with claudication. According to some recent trials an integrative therapeutic concept combining best conservative treatment - including (supervised) exercise therapy - with endovascular therapy gives the best midterm results concerning walking distance and health-related quality of life. The improved mid- and long-term patency rate with use of modern technology further supports this concept. The conservative and interventional treatment strategy are more complimentary than competitive. The current main challenge is to overcome the economic barriers concerning the availability of exercise programmes.