A challenging iliac anatomy remains a major obstacle to successful endovascular aortic aneurysm repair. The authors experienced an abdominal aortic aneurysm with bilateral common iliac artery aneurysms in a patient that had undergone femoro-femoral bypass due to left external iliac artery (EIA) occlusion. To treat this patient in a totally endovascular manner, a bifurcated stent graft was used. One iliac limb was deployed in the right internal iliac artery (IIA) and the other in the right EIA; the left IIA was embolized with coils. Here, the authors describe the procedure used and provide technical tips.