Vascular complications after total hip arthroplasty (THA) are rare and mainly occur after revision surgery, and of these complications, large artery thrombosis is relatively uncommon. Nevertheless, this complication has potentially devastating effects on the affected lower extremity. The authors report a case of acute thrombosis in an iliac artery stent and femoro-popliteal bypass graft after primary cementless THA, and include relevant literature review.