Fewer than 100 internal iliac artery aneurysms have been reported in the English literature. Of these the incidence of true aneurysms occurring after aortic reconstruction is exceedingly low. A 73-year old man presented with 7 cm asymptomatic left internal iliac artery aneurysm 12 years after repair of an abdominal aortic aneurysm with a bifurcation graft. We report our experience with this patient along with a review of the literature and recommendations for aneurysm surveillance.