The reversed saphenous vein graft, used as a bypass for 80 patients with occlusive disease and 19 patients with popliteal aneurysms, showed continued long-term patency in 80% (44) of patients without preoperative outflow obstruction but in less than 50% (17) of patients with significant outflow lesions. Endarterectomy was a less durable procedure in a comparable series. Analysis of the ultimate clinical outcome, taking into account morbidity from graft closure or advancing atherosclerosis and mortality from other cardiovascular disease indicates a satisfactory three-year result in 70% (23) of patients with mild claudication from femoral occlusion who had additional lesions. Only 26% (seven) of patients who had undergone "leg salvage" operations for intractable pain or early gangrene were alive with a functioning pain-free extremity one year after operation.