Peyronie's disease is a medically and surgically challenging condition to manage. Most surgical techniques to correct the penile deformity often shorten the penis and do not address the issue of hourglass deformity when present. We describe our indications, rationale and technique for the use of a saphenous vein graft after a curvature correcting plaque incision. In reviewing multiple series, this approach yields similar results-incidence of residual curvature: 4-20%, decreased potency: 5-20%, penile shortening: 17-40%. While harvesting the vein would require a second incision, the use of autologous vein appears to be associated with the least amount of intracavernosal fibrosis. We propose that saphenous vein is currently the best material available for tunical patching. The technique and results of circular venous grafting for patients with severe penile shortening secondary to Peyronie's disease is also discussed.