Injury to the iliac arteries remains a devastating injury with significant morbidity and mortality that continues to challenge trauma surgeons. Patients typically present in significant metabolic disarray as a result of massive hemorrhage. Damage control techniques should be employed for patients who are coagulopathic, hypothermic, or acidotic. Definitive arterial repair can be accomplished by various techniques, selection of which should depend upon the extent and location of injury. Penetrating injury typically requires open repair, whereas most blunt injuries are amenable to endovascular therapies. Early communication between the trauma surgeon, vascular surgeon, and interventional radiologist is necessary. Fasciotomies should be strongly considered in patients with injury to the common or external iliac arteries or in patients with crush injury in order to avoid development of compartment syndrome.