Common femoral artery to tibial artery bypass with reversed autogenous vein in a subcutaneous tunnel was performed in 23 patients for claudication (one), rest pain (five), or gangrene (17). Concurrent minor amputation was done in 16. Four grafts thrombosed, one was ligated for wound hemorrhage, and one failed to heal distal gangrene and resulted in amputation, for a hospital patency rate of 74% (17). One graft failed at 3 and one at 11 months for a long-term patency rate of 65% (15) with a follow-up of 3 to 29 months. These patients have relief of symptoms and have healed their amputations. A grading system was devised for the outflow tract (stages I to IV) which correlated well with graft flow. Graft flow was not predictive of early or late failure.