Over a 100 million adults undergo noncardiac surgery worldwide, and a significant proportion of these patients are elderly patients with complex medical histories undergoing vascular surgery. The risk of adverse events, especially cardiac events, increases with age. Elderly patients with significant comorbidities who undergo high-risk procedures are more likely to sustain perioperative adverse events than their healthy counterparts in the same age cohort. Perioperative management of elderly patients scheduled for vascular surgery poses a unique challenge for the anesthesiologist. This chapter will focus on the demographics of an elderly patient presenting for vascular surgery, risks of commonly performed vascular procedures, preoperative evaluation, and perioperative management of elderly patients undergoing vascular surgery.