A femoral artery to femoral vein fistula due to penetrating knife trauma to the right upper thigh sustained 33 years earlier was treated with hybrid repair. Balloon occlusion was performed at the origin of the profunda femoris artery and the common femoral artery (CFA) to control bleeding. An interposition 10 mm PTFE graft between the proximal CFA and proximal superficial femoral artery (SFA) was performed. Multiple coil embolizations were performed on the branches of the profunda femoris artery. CTA showed a persistent fistula requiring multiple repeat embolization procedures.