Abstract A patient with gangrene from unilateral aortoiliac disease and occlusion of both superficial and deep femoral arteries in the affected limb is presented. A crossover femoropopliteal bypass, which resulted in salvage of the limb, is described. The use of both long saphenous veins joined by a fluted end-to-end anastomosis to prepare an autogenous graft of sufficient length is described. Long-term patency was obtained. Crossover femorofemoral or femoropopliteal bypass is suggested for the elderly, debilitated patient who is considered a poor surgical risk. The procedure can easily be performed under local anesthesia.