Elective bilateral exposure of iliac arteries during endovascular or laparoscopic aneurysm repair is commonly performed through two retroperitoneal incisions in the iliac fossa. Larger incisions are necessary when simultaneous external and common iliac exposures are needed. We describe a new technique using a single incision for bilateral approach of the iliac arteries. Exposure of iliac arteries through this bilateral anterior paramedian retroperitoneal approach allows the introduction of endografts, crossover ilioiliac bypass, implantation of graft limbs for bifurcated bypass grafting, reconstruction of internal iliac arteries, and ligature of iliac arteries.