Patients with severe peripheral arterial disease and critical limb-threatening ischemia are at high risk for limb loss. This video presents a 76-year-old male with extensive comorbidities who underwent above-knee amputation after failed healing of a below-knee amputation. Despite patent inflow vessels, poor distal perfusion led to non-healing wounds. The patient tolerated the above-knee amputation well, with an uneventful recovery and discharge to rehabilitation on postoperative day five. This case illustrates the role of above-knee amputation in patients with severe peripheral arterial disease and non-healing below-knee amputation, emphasizing technical steps and perioperative management.