Twenty-one patients with aneurysms of the internal iliac artery were identified over a 14-year period. Group A included those patients who had aneurysms associated with aortoiliac artery aneurysms and group B were those who had isolated internal iliac aneurysms. The natural course of these aneurysms is one of progressive expansion and rupture. A pulsatile pelvic mass, often associated with compression symptoms of the neurologic, gastrointestinal, genitourinary, and peripheral venous structures, is often present. Aortography, computerized tomographic scanning, and abdominal ultrasonography are the most useful diagnostic procedures. Proximal ligation and endoaneurysmorrhaphy make up the most appropriate surgical treatment. A case report is presented of a patient who underwent successful elective embolization as an alternative method of management.