A series of 75 patients, with an average age of 65 yr, underwent the following extra-anatomic bypasses involving the crossover femorofemoral principle: femorofemoral (F-F), 54 patients; aortofemorofemoral (A-F-F), 12 patients; common iliac-femorofemoral (CI-F-F), 6 patients; and axillofemorofemoral (Ax-F-F), 3 patients. Fifty-eight of the 75 patients (77%) initially presented with rest pain or gangrene. The operative mortality rate in this high-risk group of patients was 4%. Analysis by the life-table method showed the graft patency rate to be 91.1% at 1 yr and 87.4% at 18 mo. There were no graft failures or deaths in the series of 20 patients followed longer than 18 mo. Two amputations followed graft failures and 9 of the remaining 11 amputations were done in patients with patent grafts during the same period of hospitalization, reflecting the severity of their gangrene upon admission. High-risk patients who are not suitable for crossover F-F grafts without an inflow procedure may be suitable for a CI-F-F or A-F-F bypass before being considered for an Ax-F-F bypass.