Background: Anastomotic pseudoaneurysm is an underestimated complication of aorto-iliac grafts.Case Report: This case report describes an unusual presentation of a pseudoaneurysm with a particularly complex anatomy involving both the left iliac branches, which hindered the interpretation of diagnostic studies and therapeutic management in a patient with multiple comorbidities.Conclusions: The manuscript describes a successful management of such a complication by means of an elective endovascular approach.