This experience supports continued surveillance of patients having residual iliac aneurysmal involvement. Indeed, several studies have described the progression of aortoiliac aneurysmal disease after aortic reconstruction. Most of these studies concern patients who initially underwent tube graft repair of infrarenal aortic aneurysms with varying degrees of iliac involvement at the time of initial operation. In a study by Adam et al,4 1.4% of patients undergoing aortic tube graft repair for infrarenal aortic aneurysms had progression of their disease over 5 to 112 months of follow-up. Hassen-Khodja et al5 described the need for repeated operative intervention for iliac artery aneurysm progression in 2% of their study population who had all previously undergone aortic reconstruction with an infrarenal tube graft. Although the number of patients experiencing progression of iliac aneurysmal disease after open aortic reconstruction appears small, surveillance seems appropriate secondary to the potential grave complications up to and including rupture. As evidenced by our patient, late failure of endovascular exclusion and coiling of internal iliac aneurysms needs consideration and imaging follow-up. Late events after aneurysm coiling can be anticipated based on the known risks of failure and can be identified through a structured clinical follow-up program.