Objective To investigate the clinical efficacy of endovascular treatment of the complex Trans-Atlantic Inter-Society Consensus (TASC)ⅡD aortoiliac occlusive disease (AIOD). Methods A retrospective analysis was made of the clinical data of 69 patients treated by vascular surgery for TASCⅡD aortic and iliac artery disease in the First Hospital of Shanxi Medical University. Before the operation, a therapeutic protocol was instituted according to Fontaine staging and corresponding imaging examination. All the patients were treated endoscopically and were followed up regularly for 3 to 36 months on phone or at the outpatient clinic. Analyses were made of their clinical symptoms, ankle brachial index (ABI), complications, and patency rate. SPSS statistics 17.0 was used for data analysis, and t test was used for comparison between groups. Results The overall success rate of endovascular therapy was 94.2% (65/69), and postoperative complications occurred in 4(5.8%). Sixty-five patients were followed up for more than 6 months, 4 were lost after 12 months, and 20 were lost after 24 months. ABI at 3 months after operation was significantly higher than that before admission [(0.38±0.12) vs (0.81±0.15), P<0.05]. Patency rate was 96.7%(59/61) after one year and 88.9%(40/45) after two years. Conclusion Endovascular therapy is safe and effective for TASCⅡD AIOD with satisfactory clinical outcomes and short- to mid-term patency rates.