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We describe the case of an 83-year-old woman with a patent extra-anatomic femoropopliteal bypass who developed graft thrombosis during total knee arthroplasty. Reperfusion was achieved as a result of prompt diagnosis and thrombectomy. Arterial graft occlusion is a rarely reported complication of total knee arthroplasty, although it can be limb-threatening. Early diagnosis and treatment are important.