Surgical treatment of femoro-popliteal atherosclerotic occlusion usually consists in a femoro-distal bypass. However, the associated presence of proximal lesions that reduce prosthesis inflow, or of distal lesions that increase resistances may be decisive factors in determining the outcome of the revascularisation. Frequently, an iliac or common femoral artery stenosis can be treated with an endovascular technique prior to surgery, thus increasing the bypass inflow that is going to be created. On the contrary, in the case described here, the stenosis was distal to the femoropopliteal bypass and was treated with PTA + stenting, thus increasing the run-off and the theoretical long-term patency. Therapeutic indications and technical options are discussed in the light of the recent international literature and the new achievements in terms of endovascular technique.