Until recently, Doppler sonography played a minor role in the evaluation of peripheral arterial occlusive disease. Two recent developments have made sonographic evaluation of the arteries in the lower extremity more attractive. The introduction of color flow mapping significantly shortened the examination time, and the sonographic results were found to dramatically affect the treatment of patients with peripheral arterial disease. This review article describes the changing role of arterial sonography in patients with arterial disease of the lower extremity.