The surgical management of iliac arterial trauma remains a challenging problem with a perioperative mortality rate of 30%. The high mortality and postoperative complication rate is related to the hemorrhagic shock and multiple visceral injuries usually accompanying this vascular trauma. We feel prosthetic interposition grafts should be avoided in these frequently contaminated wounds. We use two approaches to iliac arterial transposition that restore vascular continuity following long-segment iliac injuries. These techniques eliminate the need for any interposition graft. They also reconstruct with native arterial tissue of similar diameter and vascular characteristics as the injured vessel. We advocate the use of iliac arterial transposition to manage iliac arterial injuries whenever it is anatomically feasible.