Purpose: Although lipoprotein(a) [Lp(a)] is an established coronary risk factor, its relation to peripheral arterial disease (PAD) and to outcomes after lower-limb revascularisation remains uncertain. Methodology: We searched MEDLINE, Embase, CINAHL, and the Web of Science Core Collection from inception to 31 August 2024. Studies reporting PAD prevalence or post-revascularisation outcomes according to Lp(a) level were eligible. Two reviewers independently extracted data and assessed risk of bias (ROBINS-E/ROB2). Random-effects meta-analyses generated pooled odds ratios (OR) or hazard ratios (HR); heterogeneity was assessed with I². Results: Ten observational studies involving 5,794 participants met the inclusion criteria. Four studies (n = 2,830) showed that an elevated Lp(a) concentration was associated with higher odds of PAD (pooled OR, 1.81; 95 % CI, 1.37–2.39; I² = 26 %). Two case-control studies found that mean Lp(a) values were 21.8 mg per decilitre higher in patients with PAD than in controls. Among 2,964 patients who underwent lower-limb revascularisation, high Lp(a) independently increased the risk of target-lesion restenosis (OR, 3.22; 95 % CI, 2.36–4.40), major amputation (OR, 2.62; 95 % CI, 1.36–5.03), and major adverse limb events (MALE) (OR, 5.09; 95 % CI, 3.89–6.67). Elevated Lp(a) doubled the hazard of MALE over time (HR, 2.52; 95 % CI, 1.20–5.28); its association with major adverse cardiovascular events (MACE) was not significant (HR, 1.39; 95 % CI, 0.57–3.35). Conclusion: Elevated Lp(a) is associated with both the presence of PAD and substantially worse limb outcomes after revascularisation. Routine measurement of Lp(a) may refine risk stratification, and ongoing Lp(a)-lowering trials should evaluate limb-centred end points. PROSPERO registration: CRD42023481959.