Complete occlusion or high-grade stenosis of the common femoral artery (CFA) occurs infrequently, whether as an isolated lesion or associated with similar lesions in other arteries. Ten patients with this condition comprise this report. Three had severe claudication, while seven required treatment for limb salvage. Two of the patients with claudication and one with critical ischemia had isolated CFA lesions. The remaining seven had CFA disease in tandem with either inflow aortoiliac disease or associated distal occlusions. Physical examination and vascular laboratory studies failed to suggest the diagnosis in every instance. Angiography was definitive in revealing the location and extent of pathology. Patients with localized disease were treated by patch angioplasty, balloon dilatation, or by graft replacement and profundaplasty. All others required more extensive reconstructions, with important variations from standard technique being necessary because of the CFA lesion. Amelioration of symptoms was achieved in all patients.