Symptomatic bilateral iliac artery aneurysms: Four cases with four different management strategies and outcomes

•Iliac aneurysms have a wide range of symptoms leading to diagnostic delay.•Ruptured iliac aneurysms have high mortality and morbidity.•Saving at least one hypogastric arterie, when possible, is the most favourable.•The extent of pelvic ischemia after sacrificing hypogastric arteries is variable.