Objective: Hydrogen sulfide (H 2 S) is an endogenously produced gaseous signaling molecule with the potential to modulate vascular functions. Free plasma sulfide can be measured by various techniques, but no consistent relationship with cardiovascular disease has yet emerged. For example, sulfide levels are decreased in CHF patients, but elevated in PAD. We therefore sought to compare plasma sulfide levels from PAD patients to matched controls, and explore links between mortality rates and sulfide levels using two assays. Approach & Results: Patients undergoing carotid endarterectomy (n=49), open lower extremity revascularization (n=44) or leg amputation (n=22) were enrolled (mean age 68.9±9.6, 67% male). Blood was collected from 20 matched control patients, without PAD or CAD (mean age 67.9± 1.3, male 65%). Plasma sulfide was measured using two methods, first detection using lead acetate, and second using mass spectrometry. Controls had increased plasma sulfide levels measured by both methods (lead acetate, Fig. A; mass spec, Fig. B) compared to PAD patients (p<0.001, p=0.013). Also, PAD patients were divided into high (n=57) and low (n=58) sulfide (lead acetate) groups by median split. Low sulfide PAD patients had increased probability of post-op mortality (p=0.0337, Fig. C). To determine the source of plasma H 2 S detected by lead acetate, we tested the effects of detergent and proteolytic denaturation of plasma as well as of reducing agents on H 2 S release. We found denaturation increased plasma sulfide release, and that dithiothreitol was most effective at liberating H 2 S, suggesting bound sulfane sulfur as source of H 2 S detected using the lead acetate assay. Conclusions: Plasma free and bound sulfide were reduced in PAD patients compared to controls, and correlated with mortality. These findings provide evidence linking circulating sulfide to clinically meaningful events, and support directed H 2 S investigations toward diagnostic and therapeutic purposes.