© 2021, Springer Medizin Verlag GmbH, ein Teil von Springer Nature. Vascular surgery patients older than 80 years have been seen more frequently in the clinical routine over the last years. This demographic change poses a challenge to medicine and will accompany us in the future. Many studies in recent years have provided evidence of a positive impact of revascularization in chronic critical limb ischemia; however, technically possible does not always mean reasonable for the patient. Endovascular and open vascular surgical procedures are known modalities for revascularization. Good results can be achieved by using the eligible revascularization procedures, taking the comorbidities, the life expectancy and the expected patient mobility into consideration. This review article with a selective literature search aims to sensitize to the important topic of treatment options for critical limb ischemia in patients >80 years old. It also shows that each revascularization procedure has advantages and disadvantages. The treatment should be individualized for each patient.