The majority of abdominal aortic aneurysms have been treated by endovascular aneurysm repair in the past decade. Common perioperative complications after this procedure are mostly related to vascular access and improper stent-graft placement. We present the first case of bilateral lower extremity claudication due to severe angulation of the graft-aorta interface, which may have been prevented by a more critical consideration of the patient's anatomy. Treatment required open explantation and repair of the abdominal aortic aneurysms which led to complete resolution of claudication. The results of this case highlight the importance of adherence to instructions for use guidelines.