Extracorporeal shock wave lithotripsy (ESWL) for urolithiasis may result in rupture of a coexistent abdominal aortic aneurysm (AAA). We report a patient who required ESWL and who had an AAA. Open surgery was precluded by morbid obesity and persisting incisional hernias after mesh repair. Endovascular AAA repair (EVAR) with bifurcated grafts was precluded by an 11-mm distal aorta. EVAR with stacked tubular AneuRx components was performed, followed by ESWL. The AAA was excluded, and the integrity and position of the endografts were not altered by ESWL.