In this case report, we present an 83-year-old man with a ruptured para-anastomotic aneurysm who underwent a stent graft in spite of his condition of acute shock. Our patient presented at the emergency room (ER) with acute abdominal pain. Shortly after arrival, he collapsed because of a ruptured para-anastomotic aneurysm after the previous aorto-bi-iliac aneurysm repair in 1984. He was charged with a cardiac history that made him unsuitable for surgery. We chose for resuscitation followed by inflation of an aortic balloon that made the patient hemodynamically stable. He then underwent iliac stent grafting and was discharged from the hospital at 22 days after the procedure. The mortality rate of patients with a ruptured para-anastomotic aortic aneurysm arriving at hospital ranges from 32% to 70%. Endovascular stent placement for ruptured iliac aneurysmal arteries can be a safe treatment in selected patients.