Fifty-four consecutive patients, 69 years of age and older, underwent femoropopliteal reconstructive surgery. As a group, the elderly patient presented with a much higher incidence of end-stage ischemia and was found to have multiple sites of obliterative disease, particularly involving the popliteal and tibial vessels. Operative and two-year mortality were 9% and 25%, respectively, eventual amputation being required in one half of the cases. Twenty-two percent of the patients were alive at two years with a successful postoperative result. Results would indicate that a more liberal employment of tibial artery bypass would favorably influence limb survival in the elderly patient.