Revascularization of brachiocephalic arteries with prosthetic graft offers excellent patency for most reconstructions. For complex brachiocephalic reconstructions, such as redo operations or reconstructions for infection, autogenous conduit may be preferable. Occasionally saphenous vein is inadequate or absent. The purpose of this study was to evaluate the indications and intermediate-term outcomes of superficial femoral-popliteal vein (SFPV) as an alternative conduit for brachiocephalic reconstructions. Over a 6-year period, 71 patients underwent carotid, subclavian, or axillary artery bypass. In 18 (25%) of these reconstruction SFPV was used as the conduit. Ten bypasses (55%) were redo operations. Three bypasses (17%) were performed after failed prosthetic grafts. Three grafts (17%) were required in infected patients. Indications for the use of SFPV included inadequate saphenous vein (n = 13), infection (n = 3), and failed prosthetic bypass (n = 3). Thirty-day mortality was 5.5%. The neurologic event rate was 5.5%. During a mean follow-up of 26 ± 5 months, there were no graft thromboses or graft infections. Revision-free primary patency was 92% at 48 months. Assisted primary patency was 100%. These data suggest that SFPV is a safe, durable conduit for brachiocephalic reconstructions. SFPV yielded excellent results for a disadvantaged patient population.