We report our experience with the use of three saphenous vein grafts for treating advanced occlusive cerebrovascular disease in the anterior cerebral artery (ACA) in two patients. Superficial temporal artery (STA)-ACA anastomosis with interposed vein graft is thought to be indicated for patients who have STA of insufficient length to anastomose to the ACA. Vein graft has already been demonstrated to be applicable in extracranial-intracranial artery bypass, as well as in aorto-coronary bypass. Two factors considered to be essential for successful revascularization are technical proficiency, including protection from drying, smooth approximation of vessels, and proper orientation of the graft, and the relative size of donor and recipient vessels. Because the vein graft must be anastomosed with the proximal ACA to reduce the size discrepancy between vessels, prolonged interruption of circulation during suturing is inevitable. Our operative results suggest that anastomosis to a superficial branch of the ACA just distal to the interhemispheric fissure seems to be preferable to anastomosis using vein graft, and we recommend the option of vein graft only when the STA cannot be used.