Bleeding from an iliac artery injury during laparoscopy with an associated small bowel injury was managed by ligation of the right common iliac artery and revascularization of the right lower extremity with a crossover femoral–femoral graft, with repair of a small bowel injury in 2000. In 2014, the patient presented with symptoms of progressive lower extremity claudication with an occluded crossover femoral–femoral graft and underwent aorto-bifemoral graft reconstruction, which has remained patent for the past 11 years with a normal ankle-brachial index in both lower extremities and alleviation of symptoms of intermittent claudication.