A 34-year-old male with a history of infective endocarditis and mitral valve replacement presented with abdominal pain, fever, and leg pain. CT angiography revealed a ruptured common iliac artery aneurysm and femoral mycotic aneurysm. The patient underwent open surgical repair including aneurysm resection, tissue debridement, and grafting of the common iliac artery despite a ureteral injury during surgery. Blood cultures remained negative. The patient was discharged on long-term antibiotics and anticoagulation and followed up in clinic with improved walking.