BACKGROUND In May 2007, the Trans-Atlantic Inter-Society Consensus document on peripheral arterial disease management (TASC II) was released. These guidelines were developed to assist in the rational choice of open or endovascular approaches to aortoiliac disease. METHODS A 46-year-old woman was referred to the accident and emergency department, presenting with the chief complaint of pain in the left leg during activity. The pain had reduced after 10 min of resting before the time of admittance. Furthermore, there was weakness and sensory loss in the left leg; however, ulcers or gangrene were not found in the distal area. In addition, the left femoral pulse was not palpable, with ankle-brachial indices (ABIs) of 1.11 and 0 for the right and left, respectively. A computed tomography (CT) angiography of the aorta and lower limbs was requested. The findings were consistent with total occlusions from the distal portion of the aorta to the left common iliac artery, with atherosclerosis of the abdominal aorta (aortoiliac lesions type D TASC II classification). Subsequently, bypass grafting was performed immediately after revascularization with the femorofemoral artery. There were no post-operative sequelae, and the patient was admitted to the hospital for wound care. CONCLUSIONS Patients with aortoiliac occlusive disease are at risk of limb loss when revascularization is not performed and have an increased risk of cardiovascular events. The use of femorofemoral artery bypass grafting as a surgical technique had a high success rate, resulting in good perfusion to the lower extremities during a single operation.