OBJECTIVES:   To review the current epidemiology, treatment patterns, and outcomes of critical limb ischemia (CLI) in Japan. METHODS: Clinical literature review of Japanese CLI (2007-2017; English; PubMed) was completed to identify the risk factors and the current clinical outcomes of treating CLI with revascularization and/or primary amputation. RESULTS:   The incidence of CLI in Japan is 100 to 200/million/year and the main risk factors identified are older age, diabetes, kidney disease, and smoking—similar to what is seen worldwide. Japanese citizens with these risk factors; however, is steadily increasing. Japan has the highest proportion of elderly citizens in the world (38% will be >65 by 2050), a rapidly increasing prevalence of diabetes (13.5%), a higher proportion of hemodialysis patients, and a high number of smokers (19.7%). Patients that progress to CLI in Japan; however, experience very low rates of primary amputation—5% (2006-2011), 2% (2013) and 1% (2014). There is also a high utilization of revascularization procedures in Japan (43% surgical and 51% endovascular or hybrid) to treat CLI patients. The amputation and mortality rates are similar between the two treatment modalities, but endovascular treatments in Japan result in higher revascularization rates than surgical treatment. CONCLUSIONS: The changing Japanese lifestyle is increasing the number of people suffering from diabetes, kidney disease, hypertension, and dyslipidemia—thus, CLI is expected to rise and impact the Japanese healthcare system. The extremely low rate of primary amputation in Japan to treat CLI; however, suggests a Japanese standard of care with an emphasis on amputation prevention which has been shown in other studies to reduce costs and improve quality of life. One area of improvement revealed by this review is the need for better endovascular treatment technologies that lead to lower revascularization rates—another way to contain medical costs in a society with a growing prevalence of CLI.