Objective To summarize the efficacy of lower-extremity arterio-arterial graft (AAG). Methods A retrospective analysis was performed on the clinical data and follow-up outcomes of patients who received lower-extremity AAG in Longhua Hospital Shanghai University of Traditional Chinese Medicine between August 2015 and September 2021. Results A total of 7 patients with AAG were enrolled, with a mean age of (52.1±12.5) years, including 6 females. Six patients received common femoral artery-deep femoral artery AAG, and 1 patient received common femoral artery-superficial femoral artery AAG. All grafts were successfully cannulated for hemodialysis. The follow-up duration ranged from 2 to 77 months, with a mean of (31.6±26.9) months. No limb ischemia occurred during follow-up. Graft thrombosis developed in 6 patients, and stenosis was observed in 6 patients (including distal arterial anastomotic stenosis and cannulation site stenosis). Pseudoaneurysms formed in 4 patients, among whom 1 was complicated by local infection. The 2-year secondary access patency rate was 83.3%. Conclusions Lower-extremity AAG, especially common femoral artery-deep femoral artery AAG, is associated with a low incidence of distal limb ischemia and acceptable patency rates, which can prolong patients’ hemodialysis survival. However, pseudoaneurysms at cannulation sites remain a concern. This alternative access can be cautiously selected in clinical practice.