In 2006, the Society for Vascular Surgery began development of clinical practice guidelines to assist clinicians in the process of decision making. The Society selects clinical questions of high impact and evaluates the totality of evidence by identifying and conducting rigorous systematic reviews. Multidisciplinary committees follow the Grading of Recommendations, Assessment, Development and Evaluation framework (GRADE), standard consensus, and voting procedures. Factors other than evidence, including patients' values and preferences and the availability of surgical expertise, are also considered. We describe, in the context of cumulative 4-years' experience, the methods and rigor of current procedures adopted by the Society for Vascular Surgery in developing practice guidelines. We also discuss potential future efforts needed to maximize the quality, adoption, and application of the clinical recommendations. © 2011 Society for Vascular Surgery.