Critical limb ischemia, now commonly termed chronic limb-threatening ischemia, represents the most severe form of peripheral artery disease and is associated with rest pain, non-healing ulcers, gangrene, amputation, and high mortality. Endovascular therapy has become a major treatment strategy due to reduced invasiveness, repeatability, and suitability for high-risk surgical patients. This article reviews clinical evaluation, imaging, procedural techniques, outcomes, complications, and future directions in endovascular management of critical limb ischemia.