We performed several arterial reconstruction methods for five patients with buttock claudication due to ischemia of the hypogastric artery, and their symptoms improved remarkably. They had complained of severe buttock pain, although every patients' ankle brachial pressure index had almost been within the normal range. Angiography had showed not only hypogastric arterial stenosis but extensive sclerotic changes of pelvic arteries. Two cases had had contralateral iliac stenosis. We placed stress on reconstruction for the main trunks to supply the lower extremities with sufficient blood flow, and occasionally reconstructed the hypogastric artery in addition. Aorto-femoral bypass, ilio-femoral bypass, Y-graft replacement, atherectomy were performed, among other procedures. The buttock pain was eliminated. Buttock claudication, caused by critical hypogastric circulation, occurs only when blood flow through the pelvic collateral vessels is compromised. In particular, the principal etiology seems to be blood flow steal to the ischemic legs on exercise. In such cases, arterial reconstruction of the lower extremities is very effective.