Caring for a growing elderly population is a challenge facing healthcare systems globally. Geriatric patients are rightly recognized as some of the most complex and challenging to manage. This chapter provides a review of the most common challenges and unique considerations in managing geriatric emergencies in interventional radiology. Broadly, these can be categorized as pre-, intra-, and postprocedural. They include assessment of comorbidities, procedural and sedative risk evaluation, evaluation of cognitive capacity for consent and clarifying goals of care, medication optimization specifically relating to blood thinners, assessment of renal function and its implications, and evaluation of vascular health and its implications for vascular procedures. A broad overview of the available evidence-based guidelines and recommendation on approaching these challenges is provided. Lastly, the paramount importance of multidisciplinary collaboration is emphasized. Ultimately, optimizing care for the elderly can only be achieved through the elaborate contributions of a robust network of specialists, primary care physicians, and allied health professionals working together to produce care that best aligns with the patient’s wishes.