Management of superior vena caval syndrome with an autogenous vein bypass graft can be complicated by occlusion of the bypass graft. The case of a patient with recurrent superior vena caval syndrome due to occlusion of a spiraled saphenous vein graft who was managed with a femoral vein graft supported externally by a sleeve of ringed polytetrafluoroethylene is presented. A venogram demonstrated patency of the graft 11 months postoperatively, and the patient remains free from clinically apparent superior vena caval obstruction 18 months postoperatively.