A 71-year-old man was suffering from a large right internal iliac artery aneurysm (rt. IIAA) associated with acute renal failure secondary to bilateral hydronephrosis. Immediately after admission, we performed resection of the rt. IIAA and right common iliac artery-external iliac artery bypass. Postoperative recovery was uneventful and renal function improved. We should consider that a large isolated IIAA may uncommonly cause acute renal failure secondary to hydronephrosis. Expeditious surgical intervention may provide a complete recovery from acute renal failure.

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