Purpose The use of marijuana and its association with peripheral arterial disease has been well described. Anecdotal evidence at our centre has demonstrated a significant increase in patients presenting with symptomatic aortoiliac occlusive disease with a current or previous history of marijuana use. It remains unknown in the literature the association between these, as well as long-term outcomes comparing the differences between marijuana and non-marijuana users and their post-operative course. Our goal was to perform a systematic review to analyse the association between marijuana use and burden of aortoiliac occlusive disease. Methodology A systematic literature search was conducted using the Cochrane Database and OVID Medline databases in accordance with the PRISMA statement, on the 24th of June, 2024. We identified 2 articles, of which 1 (retrospective cohort study) was analysed. Given this, an observational study using the Australasian Vascular Audit (AVA) was conducted at Northern Health using a prospectively-maintained institutional database to identify patients with symptomatic aortoiliac occlusive disease who underwent operative treatment. Past medical history, including duration and amount of marijuana use was analysed using the hospital’s medical records. Results We identified 67 cases of symptomatic aortoiliac occlusive disease requiring operative intervention over a 12-month period, all of which were included in this study. The majority of patients were male (83.5%) with median age 64 (IQR 57 – 69). 40 patients had a history of documented marijuana use, with 34 being currently active smokers with >10 pack years. Conclusion Although there is limited information available in the literature showing the association of marijuana use and aortoiliac occlusive disease, our retrospective cohort study has demonstrated a positive association. Further prospective studies are warranted in this area.