We report the case of a thrombotic occlusion of an extra-anatomical aortic bypass graft performed 37 years ago in a 46-year-old male with Takayasu's arteritis. He presented with uncontrolled upper body hypertension, claudication pain in both the lower limbs, and kidney dysfunction which returned to normal post-surgery. On table we found a pseudoaneurysm at the proximal anastomosis along with calcification of the capsular tissue surrounding the graft. We attempt to explain the mechanism behind the graft occlusion, along with management of this late surgical complication which has not been described in the existing literature.