Introduction Iliac artery aneurysms pose diagnostic difficulties as they are relatively asymptomatic and hence difficult to detect and treat.1) In addition, rupture of common iliac artery aneurysm is associated with a higher mortality rate despite modern surgical and anaesthetic care.2) They are commonly seen in patients with abdominal aortic aneurysms although there is no association between the diameter of the iliac aneurysm and abdominal aortic aneurysm.3) There are reports of common iliac aneurysm developing in patients operated for infra-renal aortic aneurysms with non-bifurcating grafts. 4) In addition, there is recent evidence to suggest that in patients with abdominal aortic aneurysms, common iliac arteries measuring over 1.6 cm are prone to aneurysmal degeneration in later life and this is of relevance particularly when considering endovascular interventions. 5)The development and subsequent rupture of a common iliac artery aneurysm, which has been excluded from high-pressure direct flow from the aorta has not been previously reported. We report such a case of rupture of the common iliac artery aneurysm eight years after an aorto-bifemoral bypass graft repair for ruptured infra-renal abdominal aortic aneurysm and discuss relevant management issues. Case PresentationAn 84-year-old man with significant past medical history of cardio-respiratory co-morbidities presented with acute onset left iliac fossa pain. He had undergone an aorto-bifemoral bypass graft eight years ago for a ruptured infra-renal abdominal aortic aneurysm. A prosthetic aorto-bifemoral bypass graft was performed as the iliac arteries were severely calcified and unsuitable for anastamosis. The origins of the common iliac arteries were ligated to allow for retrograde perfusion of the internal iliac vessels via the graft. The iliac arteries were noted to be of normal calibre with no aneurysmal changes at the initial repair of the aortic aneurysm. On the current admission, an urgent contrast enhanced CT scan demon- Common Iliac Aneurysm Rupture after Previous Aortic