An experience on the surgical treatment of anastomotic false aneurysms during the last 15 years was reviewed. Fifty-nine were femoral anastomoses complicated by false aneurysm appearance requiring surgical excision. They represented 2.9% of all femoral anastomoses performed, whereas they represented 3.3% when considering reconstruction in which the femoral artery was the distal anastomosis. Reconstructions with distal anastomosis performed on the femoral artery were primarily involved (58 of 59), whereas grafts with "take off" from the femoral artery were rarely affected (p less than 0.05). A higher incidence of false aneurysm formation was demonstrated in hypertensive patients (p less than 0.05) as well as those who previously had femoral thromboendarterectomy (p less than 0.01). Infection was considered a causative factor even if it developed before (6-14 months) false aneurysm appearance. When a false aneurysm was resected, the best hemodynamic reconstruction, to avoid recurrence, was considered a bypass with distal anastomosis performed end-to-end on the femoral artery (p less than 0.05). The surgical treatment of choice was false aneurysm resection and graft interposition. However, a reanastomosis in the presence of small false aneurysms, when technically possible, has been successfully performed. Both treatments allowed good long-term results.