Purpose: Autogenous aortoiliac/femoral reconstruction with superficial femoral-popliteal veins (SFPVs) has been successfully used to treat prosthetic infection and failure, but outcome data are scant. In this prospective, observational study, we hypothesized that (1) replacement of the aortoiliac/femoral system with SFPVs could be performed with perioperative morbidity and mortality rates equal to those of conventional methods; (2) long-term patency rates would be excellent; (3) limb salvage rates would be correspondingly high; (4) aneurysmal degeneration would not occur; and (5) venous morbidity would be minimal. Methods: Since 1990, 41 patients have undergone complete or partial aortoiliac/femoral reconstruction with 63 SFPVs with a mean (± SD) follow-up time of 32 ± 21 months. With the exception of two patients lost to follow up, all have been observed at 6-month intervals with clinical examination and noninvasive tests. Results: There were no immediate operative deaths, but three patients (7.3%) died of multisystem organ failure after 1 month. Forty, nine percent of patients had significant perioperative complications including amputation (5%), compartment syndrome (12.3%), and pulmonary embolism (2.4%). Most patients (85%) had multilevel occlusive disease, and the mean SVS/ISCVS runoff score for the group was 4.9 ± 2.6 (1 = normal, 10 = no runoff). Fifty-eight percent of all distal anastomoses were end-to-end, and in 68% of limbs the profunda femoris artery or superficial femoral artery was the sole runoff vessel. At 5 years, the cumulative secondary patency rate was 100%; primary patency rate, 83%; limb retention rate, 86%; and survival rate, 69%. Four patients had permanent limb edema controlled by compression stockings but none have had venous ulceration. There has been no aneurysmal dilation of SFPV grafts, and mean diameter shown by serial duplex imaging at 6 months (10.8 ± 1.1 mm) was not significantly different from that at 60 months (7.8 ± 1.1 mm). Conclusions: Aortoiliac/femoral reconstruction with SFPVs is a successful and durable option for infection and other complex aortic problems.