Objective To determine the effect of lower extremity arterial calcification (LEAC) on the degree of lower limb ischemia in patients with peripheral arterial disease (PAD). Methods Totally 103 with PAD who had underwent CTA scan of the lower extremity in our hospital from September 2017 to March 2018 were retrospectively collected . The patients were divided into the claudication group (n?=?56) and the critical limb ischemia group (CLI) (n?=?47) according to the patient's Rutherford classification, and the baseline data of patient were recorded, such as age, gender, smoking history, drinking history, diabetes, hypertension, hyperlipidemia, CKD, etc. LEACS were measured on noncontrast computed tomography scans. Univariate and multivariable logistic regression was used to identify factors associated with the increasing degree of lower extremity ischemia. Results The LEACS of the CLI group is higher than that of the claudication group. In multivariable analysis, LEACS [OlR?=?3.252 (95% CI: 1.405, 7.523)] maintained an association with the increasing degree of lower extremity ischemia after adjusting for relevant cardiovascular risk factors. Conclusion LEACS is an independent risk factor for increased degree of lower extremity ischemia in patients with PAD. Further research aimed at understanding the relationship between arterial calci cation and worsening limb ischemia is warranted.