This study states that Endovascular treatment of common iliac artery (CIA) and internal iliac artery (IIA) aneurysms using an iliac branch endoprosthesis (IBE) has been safe and effective. Instructions for use require deployment of current IBE technology with the corresponding manufacturer’s modular bifurcated aortic endograft. Concomitant aortoiliac occlusive disease, inadequate renal artery to iliac bifurcation length, and unfavorable aortic anatomy preclude on-label IBE deployment. Herein, we present the technical feasibility and safety outcomes of alternative aortic endograft platforms circumventing aortoiliac anatomy preclusive to current IBE technology. In five consecutive patients with CIA or IIA aneurysms, computed tomography angiography and centerline reconstruction revealed aortoiliac anatomy incompatible with the current IBE instructions for use criteria because of a combination of inadequate renal artery to iliac bifurcation length (n = 5), inadequate proximal CIA landing zone (n = 4), or compromised aortic anatomy (n = 2). To overcome these restrictions and to facilitate IBE deployment, we performed aortoiliac reconstruction using the AFX (Endologix, Irvine, Calif) or Endurant II (Medtronic, Santa Rosa, Calif) platform (Fig, B). All IIA reconstructions and external iliac artery extensions were performed using the Gore VBX stent grafts (W. L. Gore & Associates, Flagstaff, Ariz). Technical success was defined as successful delivery of all endograft components without migration or endoleak.