We report three cases of late axillary artery thrombosis after axillofemoral bypass grafting. In each patient the artery was found to have been pulled down by the graft and angulated sharply. This is an important complication, which resulted in the loss of a limb in one patient. It is recommended that the upper anastomosis must be explored without delay. Anticoagulation or attempts to clear the thrombus with the more distal branchial artery approach are unlikely to be successful and serve only to delay definitive management.