To evaluate the role of three-dimensional computed tomographic angiography (3D-CT) in peripheral artery bypass surgery, 49 patients with chronic lower limb ischemia underwent 3D-CT before and after a bypass operation. 3D-CT had a sensitivity of 96.8%, a specificity of 95.0% and an overall accuracy of 96.1% for the diagnosis of arterial and graft stenosis or obstructions. The ability to observe the acquired images at any angle was very useful for assessing the implanted graft in both aortoiliac and infrainguinal bypasses. Although these images equally identified arterial stenosis, obstruction, and the anastomotic morphology of bypass grafts as well as conventional angiography, the diagnostic accuracy was not helpful in the small arteries and grafts. 3D-CT is a low-invasive imaging method that is sufficient for forming strategies for bypass operations. In aortofemoral or femoropopliteal bypass surgery, 3D-CT thus provides sufficient imaging accuracy for bypasses up to the popliteal artery below the knee in patients with chronic limb ischemia.