Aneurysm degeneration of internal carotid artery interposition vein grafts can occur, and their repair can be complicated by repeated neck dissection and difficulty in obtaining distal artery control. We used a covered stent graft to exclude a large internal carotid artery interposition vein graft aneurysm. Retrograde flow was induced in the internal carotid artery so that an embolization protection balloon could be placed through the aneurysm. The stent graft was then placed with embolization protection. The repair was performed without complication, and the aneurysm remained successfully excluded at 6-month follow-up.