Twenty-seven patients with isolated hypogastric artery aneurysms and 35 patients with multiple aneurysms associated with hypogastric lesions previously reported are analyzed. The incidence and etiology of hypogastric aneurysms in addition to the age, symptoms, physical findings, evaluation, and treatment of patients with such lesions are discussed. The high incidence of rupture is noted, and operative considerations for such patients are stressed. Anatomical considerations influencing maintainence of the pelvic circulation in the presence of bilateral hypogastric aneurysms or those in conjunction with aortic aneurysms are discussed.