Iliac artery aneurysms (IAA) are more common in males, can be unilateral or bilateral with equal frequency and the majority are associated with abdominal aortic aneurysms (AAAs). The pathogenesis of iliac artery aneurysms is thought to be similar to that of AAA and shares that most are diagnosed incidentally in asymptomatic patients. The natural history of IAA is to progressively enlarge and rupture. Smaller (<3 cm) isolated iliac artery aneurysms are estimated to grow at a rate of about 0.5–1.1 mm/year, but when they exceed 3 cm in diameter they enlarge at a faster rate (over 2.6 mm/year). The risk of rupture of iliac artery aneurysm can approach 75% when they reach a diameter of 5 cm. Approaches for repair each have risks and benefits, where open repair offers the greatest assurance of a lasting repair and perhaps better for younger patients or after failed endovascular approaches, although the short-term morbidity is greater. Patients who are at higher risk for open repair, technically difficult to access (obese or reoperations), and/or relatively older are best served with an endovascular approach. Modern endovascular endografts no longer sacrifice internal iliac artery flow, especially iliac branched devices (IBD) which have encouraging early and midterm results, although these are all reported with concomitant AAA repair so isolated CIA or internal iliac artery aneurysm data is lacking.