Endovascular repair of iliac artery aneurysms has emerged as an alternative to traditional open surgical repair. Although there is little consensus on indications to preserve hypogastric blood flow during aneurysm repair, it is well understood that complications from bilateral hypogastric occlusion may be significant. The GORE EXCLUDER Iliac Branch Endoprosthesis (W. L. Gore and Associates, Flagstaff, Ariz) received United States Food and Drug Administration approval in March 2016 for treatment of common iliac artery and aortoiliac aneurysms. This case report discusses an off-label use of GORE EXCLUDER Iliac Branch Endoprosthesis to maintain pelvic perfusion during treatment of bilateral internal iliac artery aneurysms without surrounding aortoiliac pathology.