Peripheral Arterial Disease (PAD) represents a significant health challenge, especially in its advanced stages, where therapeutic options often shift from curative to palliative. This review explores current literature on the use of palliative care in advanced peripheral arterial disease and the strategies available. Advanced PAD is frequently characterised by chronic limb threatening ischaemia (CLTI), leading to chronic pain, non-healing ulcers, and potential limb loss. Traditional management emphasises revascularisation and medical therapy; however, in advanced stages, these interventions may no longer be viable, necessitating a pivot to palliative care. Recent studies highlight the importance of a multidisciplinary approach, integrating pain management, wound care, and psychosocial support. Pain management is a cornerstone of palliative care, and a combination of pharmacologic interventions and non-pharmacologic therapies can be effective. Psychosocial support, addressing the emotional and mental health challenges faced by patients with advanced PAD, has gained attention. Studies emphasise the role of counselling, support groups, and family involvement in improving patient well-being. Current literature also explores the role of patient education in enhancing self-management and decision-making. Unfortunately, palliative care has been underutilised in this patient cohort. Furthermore, the involvement of palliative care has been closer to patient death rather than to their time of diagnosis of ‘no option’ CLTI. In conclusion, palliative care in advanced PAD requires a comprehensive, multidisciplinary approach. Further efforts are required to increase the early involvement of palliative care in CLTI patients.