Femoral artery anastomotic aneurysms present as a late complication of aortofemoral graft reconstruction for aortoiliac occlusive disease and aneurysmal disease. The most common contributing factor is degeneration of the arterial wall, compliance mismatch, repeated hip flexion, and infection. Diagnosis is based on the presence of asymptomatic pulsatile groin mass, which can be confirmed by femoral duplex imaging and CTA. Aneurysms larger than 2.5 cm should be repaired with interposition synthetic graft, but profunda femoris artery may need to be reimplanted into the interposition graft, or a separate bypass to the profunda femoris artery should be performed. Recurrent femoral anastomotic aneurysm may occur with longer follow-up.