Although less invasive than the open surgical alternatives by far, endovascular surgery is not free of complications. In a systematic review of endovascular treatment of extensive aorto-iliac occlusive disease mortality ranged from 1.2% to 6.7%. Complications were reported in 3% to 45% of the patients. In this article we give a systematic overview of the most frequent complications of endovascular aorto-iliac interventions, including suggestions how to manage and how to avoid them. Careful case selection, a high level of expertise of the operator and continuous monitoring of outcome are factors that can help to reduce complications, but also the alternative of open and laparoscopic surgery should kept in mind. The lowest complication rate will result from a treatment tailored on the individual patient and the available local experience.