Of all the peripheral vascular conditions in which the surgeon has employed some form of vascular graft or prosthesis, arteriosclerotic occlusive disease has proved to be the most difficult to conquer. In some patients with this condition the serious involvement of all the vessels of a limb, including the smaller distal arteries, makes the use of a graft impractical, since its continued function or benefit is very unlikely in such a compromised arterial tree. In other patients with intermittent small areas of complete or partial occlusion, success with grafts has been transient at times because the surgeon has not completely excluded potential areas of subsequent occlusion in a major peripheral artery. However, added to these failures must be those relating to surgical technique. Imperfect anastomoses, a poorly executed associated thrombendarterectomy, and unsuitable graft material have contributed to the list of failures in at least the early cases of most hospitals.