Background and Aims Endovascular aneurysm repair (EVAR) has become the preferred treatment for abdominal aortic aneurysm (AAA) due to its minimally invasive nature and quick postoperative recovery. Iliac limb occlusion (ILO) is a common complication after EVAR, but its management poses many challenges. Therefore, this study was performed to explore the treatment strategies and risk factors for ILO following EVAR.Methods The clinical data of 14 cases of ILO that occurred after EVAR admitted to Department of Vascular Surgery, Hainan General Hospital/Hainan Affiliated Hospital of Hainan Medical University between August 2013 and August 2022 were retrospectively analyzed, and 435 EVAR cases without ILO during the same period served as a control to analyze the risk factors for developing ILO after EVAR.Results The average operative time for the 14 patients undergoing endovascular or hybrid surgery was (183.9±32.6) min, with intraoperative blood loss of (187.1±70.2) mL. Thrombus removal and restoration of intravascular blood flow were achieved through hybrid surgery in 10 cases. In two cases where hybrid surgery failed, bilateral femoral artery bypass grafting was performed. Another two cases underwent percutaneous mechanical thrombectomy using an aspiration catheter to restore intravascular blood flow. After thrombus removal from the iliac limb, balloon dilation and stent angioplasty were performed on the iliac limb and distal external iliac artery (EIA) for residual stenotic lesions. After the operation, ischemic symptoms in the lower limbs were relieved entirely in all patients. During the follow-up period, no recurrence of ischemic symptoms was observed. Univariate analysis indicated that factors such as the diameter of the proximal EIA (P=0.045), iliac artery tortuosity≥60°(P=0.003), iliac artery stenosis ≥50% (P=0.007), the distal portion of the iliac limb graft anchoring to the EIA (P=0.015), and the oversize rate of the distal iliac limb graft ≥15% (P=0.028) were associated with the occurrence of ILO after EVAR.Conclusion Endovascular or hybrid surgery is the preferred treatment for ILO following EVAR. Attention should be paid to the risk factors for ILO, and proactive prevention should be undertaken during EVAR planning and operation.