Fibrinogen, an inflammatory marker as well as a fundamental part of the coagulation cascade, is suggested to play a significant role in the pathogenesis of atherosclerosis and complications of atherothrombotic diseases. The aim of this study was to determine if plasma fibrinogen is an independent risk factor for long-term survival in patients with peripheral artery disease (PAD). Altogether, 139 Chinese patients (88 men, 51 women) with PAD were consecutively recruited for the study. Atherothrombotic risk factors and fibrinogen levels were determined at presentation, and all patients were followed up for mortality prospectively. The mean follow-up was 6 years. All variables were first correlated with survival rates using Kaplan-Meier analysis and compared by means of the log-rank test. Significant risk factors were identified, and multivariate Cox regression analysis was used to evaluate the independent contribution of the fibrinogen level to the risk of mortality. During follow-up, 95 patients (68.3%) died. The overall survival rate was 77.7% at 3 years, 56.8% at 5 years, and 31.2% at 10 years (standard errors 0.05, 0.06, and 0.07, respectively). All-cause mortality rate increased with an elevated fibrinogen level. Eighty percent of patients with a fibrinogen level > 3.4 g/L had a survival time of less than 3 years (p = 0.002). This relation was also demonstrated within patients with critical ischemia. The plasma fibrinogen level was thus identified as an independent risk factor for mortality in PAD patients after adjusting for confounding factors.