Peripheral vascular disease (PVD) is a common disease mostly involving arteries of the extremities. It usually results from progressive narrowing of arteries in the lower extremities, caused by atherosclerosis. 1 PVD prevalence in the United States has ranged as high as 30% in adult populations and is closely associated with elevated risk of cardiovascular disease morbidity and mortality. 2, 3 It is estimated that by 2020, 7 million people aged older than 40 years will suffer from PVD. Severe limb pain, claudication, ulcerations, and limb amputation are common complications of PVD, especially among patients with kidney disease and diabetes. 4, 5 The universal treatment approach for PVD includes risk-factor modification, pharmacologic therapy, and revascularization. 6 Early in the 1980s, individuals with refractory ischemic pain attributed to PVD were treated with spinal cord stimulation (SCS). 7 Since then, multiple studies have shown proved efficacy of SCS in PVD. Other studies inquired into the pathophysiology and mechanism of action; the changes in tissue oxygenation and blood flow were considered as markers for response. It was also consistently shown that SCS significantly improved multiple outcomes, such as exercise tolerance, limb salvage, and pain level in patients presenting with critical leg ischemia. 8 This article describes the role of SCS in the treatment of PVD, the patient selection criteria along with the outcomes, and mechanism by which SCS works in PVD.