The substantially high morbidity and mortality rates for graft replacement of aortic aneurysms, particularly in high-risk patients, have encouraged the development of an endoluminal approach to treatment. The introduction of endovascular stent-graft repair for aortic aneurysms has engendered considerable enthusiasm and interest from vascular specialists [1]. With progressive improvement in imaging, clinical experience, and stent-graft design, and the use of adjuvant procedures, a substantial number of patients are now candidates for endovascular repair of an aortic aneurysm [2]. Endoluminal aneurysm repair, however, currently is at a critical point [3,4]. Unquestionably, endoluminal aneurysm repair can reduce substantially the need for intensive care and length of hospital stay, and survival is reportedly improved when compared with open repair. Although the use of stent-grafts for the treatment of thoracic and abdominal aneurysms has increased dramatically, there is little midterm or long-term proof of its efficacy [1]. With longer follow-up, complications are reported with increasing frequency [3-5]. The majority of failures may be asymptomatic initially, but, if untreated, can result in fatal aneurysm rupture [6� 8]. Such complications may not appear until months or years after apparently successful endoluminal repair; therefore, although endovascular stent-grafting of aortic aneurysms is less invasive and potentially effective in the long term, it often is not a definitive procedure [6,9]. The need for lifetime surveillance, the probability of graft failure, and the need for reintervention negate some of the advantages. The small incidence of unpredictable rupture following endoluminal aortic aneurysm repair is a timely reminder of the need for caution and continued careful follow-up. In addition, the need for life-long surveillance substantially adds to the overall cost of the procedure.