Acute thrombosis of the common femoral artery was treated with interposition of an 8 mm PTFE graft following major blunt trauma with fracture of the pelvis. Eight months later, graft occlusion resulted in ischemic symptoms of the right lower extremity. An interposition spiral vein graft resulted in significant improvement in the symptoms of chronic limb ischemia. The patient was lost to follow-up for approximately 20 years because he moved out of state. He subsequently presented with recurrent ischemic symptoms resulting from occlusion of the spiral vein graft. A crossover femoral–femoral graft with lateral tunneling of the graft in the upper thigh to avoid a hostile groin was performed. However, the graft occluded 18 months after its reconstruction. The patient continues to have the symptoms of intermittent claudication, and since his respiratory difficulties have progressed, it was decided that no further intervention should be performed for symptoms of stable intermittent claudication.