Inflammatory conditions are a rare cause of aortic aneurysms, accounting for 3% to 10% of cases. Patients with ankylosing spondylitis uncommonly present with ascending aortic aneurysms related to long-standing, aggressive disease. We review the case of a young man with ankylosing spondylitis exhibiting complex inflammatory aortic aneurysms atypically involving the abdominal and descending thoracic aorta, as well as ectasia of medium-sized visceral vessels. Inflammatory aneurysms require a multidisciplinary approach incorporating diagnostic modalities to confirm etiology, targeted immunosuppressive therapy to control disease activity, and aneurysm repair. Evidence suggests that endovascular approaches should be considered first-line therapy for patients requiring reconstruction when anatomy is appropriate.