Background: Serving as an inflammatory biomarker in patients under regular hemodialysis (HD), the arterial tissue expression of vascular cell adhesion molecule 1 (VCAM-1) in patients with different renal function has rarely been investigated and remains unclear. Methods: Fifty-one consecutive patients with peripheral arterial disease (PAD) who underwent percutaneous transluminal angioplasty were recruited and divided into a normal renal function group, chronic kidney disease (CKD) group, and HD group. Background disease, clinical and angiographic severity, and serum level of VCAM-1 in the three groups were analyzed. The tissue expression of VCAM-1 was quantitatively demonstrated by immunohistochemical (IHC) staining and protein extraction from cell membranes in another amputated cohort. Results: In PAD patients, the serum level of VCAM-1 was significantly elevated in the HD group compared with the other two groups (1990.2 ± 607.1 ng/ml vs. 1547.9 ± 511.2 ng/ml vs. 1161.0 ± 435.8 ng/ml, p < 0.001). Serum VCAM-1 was a prognostic factor of major adverse cardiac or limb events (odds ratio: 1.002, 95% confidence interval: 1.001-1.003, p = 0.003). The expression of VCAM-1 was higher in the PAD amputated arterial tissue of CKD and HD patients as demonstrated by quantitative analysis of IHC staining and quantitative membrane protein extraction. Conclusions: VCAM-1 is a cardiovascular prognostic biomarker. Both serum level and the tissue expression of VCAM-1 were significantly higher in PAD patients with advanced kidney disease.