Objective To evaluate the treatment and preventive measures for iliac artery rupture during the process of endovascular therapy.Methods From June 2004 to July 2013,there were 12 cases suffering from iliac artery rupture during endovascular treatment.Of those,rupture was caused by balloon dilation in 5 cases,caused by catheter or guide wire perforation in 4 cases and after stent graft convery sheath insertion in 1 case,rupture took place because of perforation from metal stent end in one,and by withdrawing of dual-cavity thrombectomy catheter in one.Rupture involved common iliac arteries in 4 and external iliac arteries in 8.Results The 4 cases in which rupture was caused by catheter and guide wire perforation were cured,and all 5 cases in whom rupture caused by balloon dilation were cured by balloon tamponading and coverd stent.Rupture caused by stent graft inserting was successfully repaired by open operation in 1 case,but subsequently died from DIC one day after.A tardive rupture after metal stent end perforation was treated with coverd stent successfully in one case.Another case in which dual-cavity thrombectomy catheter was the cause of rupture was treated with bare metal stent,and died of massive hemorrhage of gastrointestinal tract 2 days later.6 cases treated by coverd stent were followed up for (56 ± 12) months with stents patency in all cases,and there were no in-stent restenosis nor pseudoaneurysm.Conclusions In preventing iliac artery rupture,the sufficient evaluation of femoral and iliac artery before operation is necessary,and therefore proper size balloon and soft metal stent should be used.The placement of coverd stent is effective emergency treatment.