Cross-femoral venous bypass with below-knee great saphenous vein maintains patency for over 35 years despite multiple surgical revisions.

The long-term clinical outcome of cross-femoral venous bypasses is rarely described. We present a case of a 60-year-old man who maintained secondary graft patency for 35 years after left common iliac vein ligation owing to trauma, with multiple subsequent surgical revisions for symptomatic complications. This case supports the clinical durability and potential for extended patency of cross-femoral venous bypasses, underscoring the necessity of continuous patient surveillance and intervention.