Despite continued advances in vascular surgery and the resultant improvement in infra-inguinal bypass graft patency, graft failure remains a distressing and challenging problem for all vascular surgeons. All these operations have an intrinsic tendency to fail or become ineffective as time elapses. The proportion of such operations undergoing this fate increases with time and is greater at all times for reconstructions terminating more distally in the arterial tree. Because a sizable minority of patients undergoing these operations have circulatory deterioration in their lifetimes and because this deterioration often is associated with disabling or limb-threatening manifestations, appropriate management of this condition has become an extremely important aspect of vascular surgery and one to which the competent vascular surgeon must be committed in order to serve the patients’ interests well. Vascular surgeons must maintain an aggressive attitude toward these secondary procedures when a primary procedure fails to achieve or maintain its intended goal and when a patient is faced with the imminent loss of a lower limb because of distal ischemia. The different options available include a wide variety of procedures, either to salvage a failing graft before the actual thrombosis or to manage an already failed bypass. Over a period from January 2003 and June 2004, 35 patients that were in need of a secondary vascular procedure, were subjected to 46 re-do vascular intervention. The procedures offered to these patients included bypass procedures from different parts of the arterial tree whether anatomical or extra-anatomical, thrombectomies, endartrectomies with patch angioplasties.