The objective of this paper is to review the state of art on integrated water resources management (IWRM) approaches for sustainable irrigation at the basin scale under semi-arid and arid climatic conditions, with main emphasis on Latin America, but including case studies of other semi-arid and arid regions in the world. In Latin America the general concept of IWRM has proved to be hard to implement. Case studies recommend to develop the approach from lower to upper scale and oriented at the end-user. As IWRM is an interdisciplinary approach and used for very different objectives, the main emphasis is given to IWRM approaches for sustainable irrigation and their environmental aspects. The review shows that in Latin America the environmental impact is mostly analysed at the field level, the impact on the whole basin is less considered. Many publications present the development of models, advisory services and tools for decision support systems at a high technical level. Some papers present studies of environmental aspects of sustainable irrigation, especially for salt affected areas. Multi-criteria decision making models are developed for irrigation planning and irrigation scenarios are used to show the impact of different irrigation management decision. In general integrated approaches in Latin America are scarce.