Aneurysmal disease of the hypogastric branches is rare; it may be life-threatening, and the treatment is often challenging. Herein, we report the case of an 81-year-old man with arterial hypertension, obesity, renal insufficiency, and psychiatric disorders who was emergently admitted for a symptomatic ruptured aneurysm of a hypogastric arterial branch, as seen on magnetic resonance angiography. Endovascular treatment was performed by means of a dual approach: distal embolization with microspheres and Gianturco coils, followed by proximal complete exclusion via deployment of a stent-graft in the common iliac artery. The outcome was favorable, with complete exclusion of the aneurysm and normalization of renal function. Endovascular treatment with distal embolization and proximal stent-graft release can be safe and effective, and the technique can be used in emergency circumstances with good morphologic and clinical results.