Objective: To compare the efficacies, complications and follow-up results between open surgical revascularization and endovascular recanalization in treatment of chronic iliac arterial occlusive disease, so as to guide treatment selection of these patients. Methods: Sixty-seven patients with chronic iliac arterial occlusive disease were randomly designated to undergo open surgical revascularization or endovascular interventional therapy. The efficacies, complications and follow-up results between the two groups were analyzed and compared. Results: In the open surgical treatment group, 30 cases underwent bypass operation (anatomic vascular revascularization in 24 cases and left to right femoro-femoral bypass in 6 cases), and 4 cases underwent patch angioplasty. In the interventional treatment group, 7 cases underwent balloon dilatation alone, 23 cases underwent balloon dilatation plus stent implantation, and interventional procedure was unsuccessful in 3 cases. Thirty days after surgery, the patency rates of reconstructed vessels of open surgical treatment group and interventional treatment group were 100% and 96.7%, and their overall effective rates were 97.1% and 84.8%, respectively. The incidences of perioperative complications of open surgical treatment group and interventional treatment group were 35.3% (12/34) and 20.0% (6/30), respectively. The follow-up period ranged from 13 to 65 months. The patency rates of the reconstructed vessels and symptom relief rates between the two groups had no significant differences during the first year after surgery (all P>0.05), however, from second year after surgery, the patency rates of the reconstructed vessels and ABI value of open surgical treatment group were significantly higher than those of interventional treatment group, and the symptoms such as intermittent claudication and rest pain of open surgical treatment group were less evident (all P<0.05). Conclusion: Both open surgical revascularization and endovascular interventional therapy have substantial efficacy in treatment of chronic iliac arterial occlusive disease. By comparison, open surgical revascularization has better long-term efficacy but greater risk of complications, while endovascular interventional therapy is an ideal choice for patients of old age and poor general condition contraindicating surgery.