Background and Aims Internal iliac artery lesions can cause various clinical symptoms, and aggressive treatment can significantly improve patients' prognosis and quality of life. Open surgery is the classic method for treating iliac artery lesions, but it requires higher technical demands and carries greater risks for patients. Endovascular techniques for reconstructing the internal iliac artery have been widely applied, with current progress mainly focusing on the treatment of concomitant abdominal aortic aneurysms, and there is limited research specifically targeting the internal iliac artery lesions. Furthermore, due to the complexity of lesion types and anatomical structures, there are no specialized guidelines or expert consensus at home and abroad to guide the diagnosis and treatment of internal iliac artery lesions, and there is a lack of standardized protocols for endovascular treatment techniques. This requires clinicians to develop individualized strategies based on the characteristics of the lesions, anatomical considerations, and personal experience. Currently, the more widely used and technically mature endovascular treatment methods include endovascular angioplasty and stent placement, while for those with concomitant external iliac artery lesions, "sandwich"technique and branch stenting have their advantages and disadvantages. This study was performed to observe the short-term treatment outcomes of employing the aforementioned commonly used endovascular repair methods and selecting different reconstruction strategies based on the individual conditions of patients with internal iliac artery lesions, to explore the feasibility of using personalized endovascular techniques for reconstructing the internal iliac artery.Methods The data of 13 patients with isolated iliac artery lesions who underwent internal iliac artery reconstruction at the National Cardiovascular Center from November 2015 to June 2022 were retrospectively analyzed. The primary endpoints were the incidence of postoperative symptoms of internal iliac artery ischemia such as buttock claudication and erectile dysfunction. The secondary outcome variables included such as the patency of blood flow and the presence of endoleaks, stent displacement, restenosis on aortic CTA at least 1 month after the procedure.Results Among the 13 patients, there were 12 males and 1 female, with a mean age of 62 (46-73) years. Based on preoperative imaging findings and the characteristics of the lesions, appropriate surgical methods were selected. Among them, 8 cases with internal iliac artery stenosis at the ostium were treated with simple balloon angioplasty, 4 cases with iliac artery aneurysm, dissection, or penetrating ulcers were treated with covered stent endovascular exclusion, and 1 case with common iliac artery aneurysm and iliac artery involvement was treated with the "sandwich"technique. All patients successfully underwent unilateral iliac artery revascularization without perioperative complications such as myocardial infarction, major bleeding, limb embolism, or death. The median follow-up time was 3.9 (1-22) months. During the follow-up period, none of the patients experienced ischemic symptoms in the iliac artery supply region. The CTA results showed that the blood flow in the ipsilateral iliac artery and external iliac artery was unobstructed, and the stent morphology and position were normal, with no evidence of endoleaks, embolism, or aneurysm expansion. Two cases with severe stenosis at the internal iliac artery ostium treated with simple balloon angioplasty showed moderate residual stenosis on follow-up at 3 months after operation, but both were relieved compared to the preoperative condition.Conclusion The application of endovascular techniques for treating internal iliac artery lesions is safe and feasible. The specific surgical approach should be selected based on individualized conditions.