Iliac arteries in allograft pancreas recipients may be compromised by the patient's underlying disease or previous surgical intervention. We describe a previously unreported arterial reconstruction using an extended segmental common/external iliac artery patch with anastomosis of the pancreatic Y-graft to the patch internal iliac artery, and review the options for arterial reconstruction reported by others. This technique may find application in both pancreas and kidney transplantation to salvage a damaged or diseased iliac artery.