Complex femoral anastomotic aneurysms include those of large size (greater than 5 cm in AP/TR diameter); those that presented rupture, acute thrombosis, and recurrent femoral anastomotic aneurysms; and those that presented with severe ischemia of the lower extremity due to associated severe lower extremity arterial occlusive disease. In patients presenting with rupture or those with a very large-sized aneurysm, proximal control should be obtained using a suprainguinal retroperitoneal exposure of the graft limb. Patients presenting with rupture and thrombosis have a higher morbidity and mortality rate than those having elective repair for complex femoral anastomotic aneurysms (FAAs).