tion a left iliac extension limb 16×16×85mm as well. Medical comorbidities included chronic obstructive pulmonary disease secondary to nico­tine abuse (80 pack years). She also had evidence of lower extremity arterial occlusive disease with slightly diminished bilateral femoral pulses. Popliteal posterior tibial and dorsalis pedis pulses were absent, and ankle brachial index was 0.6 on the right and 0.5 on the left due to bilateral super­cial femoral artery occlusive disease. Past surgi­cal history included left carotid endarterectomy. Follow-up CTA of the abdomen and pelvis and abdominal duplex ultrasound showed no evi­dence of endoleak and gradual diminishing in size of the aneurysm sac. During follow-up (2014), the ankle brachial index on the right side decreased to 0.46 and on the left side to 0.42. CTA of the abdomen and pelvis (July 2015) showed successful exclusion of the AAA with patent bilateral renal arteries; however there was evidence of stenosis at the distal end of the left common iliac stent graft, and there was evidence of diffuse narrowing of the left external iliac artery (Fig. 67.2). Patient refused any further intervention for arterial occlusive disease. In July 2018, patient was seen in the outpatient clinic with ischemic rest pain and dry gangrene of the tip of the left big toe. She underwent CTA (Fig.67.3) and abdominal aortography with run­off which showed occlusion of the left limb of the aortobifemoral graft which had been performed 8 years and 8 months previously.