We describe a case of radiation injury to the superficial femoral and upper popliteal arteries in a 39-year-old man treated 13 years earlier for an osteosarcoma of the right femur. Following two failed attempts at transluminal angioplasty, a saphenous vein femoropopliteal bypass graft was performed successfully. A comprehensive review of the literature on radiation-induced arterial injury to the limbs is presented with a discussion of the different management options. Percutaneous transluminal balloon angioplasty seems to have no place in the treatment of such lesions.