There have been considerable advances in the management of patients with aortoiliac occlusive disease. While endovascular procedure is the treatment of choice for Trans-Atlantic Inter-Society Consensus (TASC) type A and is more often used in TASC type B iliac lesions, recent studies report encouraging results in patients with intermittent claudication suffering from TASC type C and D iliac disease. Modern surgical techniques have been proposed for the treatment of high-risk subjects with critical limb ischemia due to advanced aortoiliac disease. Combined or hybrid interventions involving endovascular and open procedures performed either successively or intraoperatively are becoming more popular as vascular surgeons acquire endovascular skills. However, the long-term results of these therapies especially in the presence of multilevel occlusive lesions still remain uncertain.