Aortoenteric fistulae (AEF) are now known to occur following endovascular repair of abdominal aortic aneurysms (AAA), presumably because of mechanical forces of dislodged or migrating devices. We present an unusual case of fistula development between the ileum and an AAA presenting as a graft infection following endovascular AAA repair in the absence of direct mechanical strain. Continued pressurization of the aneurysm sac due to endoleak may predispose to this event, especially in large aneurysms. Aggressive surveillance and early interventions are necessary following all endovascular AAA repairs.