Background: Endovascular interventions often are the preferred treatment in peripheral arterial disease for both intermittent claudication and chronic critical limb ischemia. Ever more advanced and anatomically complex procedures are being performed, which may increase the radiation exposure of patients and medical staff. We sought to determine the radiation exposure sustained in contemporary interventional radiology practice. Methods: A single-center observational cohort study of patients undergoing endovascular interventions for symptomatic peripheral arterial disease between January 1st, 2011 and July 31st, 2013 was performed. Radiation dose area product (DAP), peak skin dose (PSD), fluoroscopy time, and volume of contrast media were either measured or calculated and stratified according to patient demographics and anatomic location. Results: In 951 patients, who were treated with endovascular interventions, mean DAP was 108 +/- 88 Gy x cm(2) and mean fluoroscopy time was 13 +/- 12 min. DAP was significantly higher for aortoiliac procedures (142 +/- 103 Gy x cm(2)) compared with femoral (58 +/- 73 Gy x cm(2)), below-knee (45 +/- 51 Gy x cm(2)) and multilevel (83 +/- 90 Gy x cm(2)) procedures (P <0.001 for all comparisons). PSD was significantly higher for aortoiliac procedures (0.99 +/- 0.54 Gy) compared with femoral (0.55 0.55 Gy), below-knee (0.48 +/- 0.27 Gy), and multilevel (0.68 +/- 0.47 Gy) procedures (P <0.001 for all comparisons). In contrast, mean fluoroscopy time in aortoiliac interventions was significantly shorter (10 +/- 15 min) compared with femoral (15 +/- 12 min), below-knee (19 +/- 10 min), and multilevel (23 +/- 14 min) procedures (P <0.001 for all comparisons). Conclusions: Endovascular interventions in patients with symptomatic peripheral arterial disease involve a substantial radiation dose. Although fluoroscopy time is shorter, aortoiliac interventions result in greater radiation exposure than femoropopliteal or infrapopliteal interventions.