A 74-year-old male claudicant had undergone operative repair of his bi
lateral varicose veins 22 years earlier. His records confirmed that on
the right side he had only had a saphenofemoral disconnection. Duplex
scanning and angiography of his right leg demonstrated an occluded su
perficial femoral artery (SFA) and a network of channels between the p
roximal SFA stump and the long saphenous vein (LSV). Distal SFA recons
titution occurred through two distal arteriovenous fistulas. We believ
e that this is the first case of a spontaneous femorodistal bypass gra
ft secondary to neovascularisation recorded in the literature.