Isolated aneurysms of the internal iliac artery (IIIAA) represent a rare pathology. The application of endovascular therapy has been shown to reduce both mortality and blood loss. We present a case of an isolated left internal iliac artery aneurysm treated with a hybrid approach. A 92-year-old male was found to have an asymptomatic 4.6-cm aneurysm of the left internal iliac artery. He underwent coil embolization of 3 branch outflow arteries of the aneurysm. With completion angiography confirming no distal flow, we performed open ligation of the left internal iliac artery at its origin with minimal blood loss. The patient experienced no pelvic ischemia symptoms following repair. Computed tomography (CT) scan confirmed aneurysm exclusion at 4-year follow-up. The hybrid approach to IIIAA in the nonagenarian population is a viable alternative and may confer significant improvements in outcomes and blood loss.