Although crossover femorofemoral grafts have had good long-term patency, all patients have not been symptomatically improved. Seventy-one patients underwent 80 femorofemoral bypasses from 1968 to 1978. Hemodynamic assessment included preoperative and postoperative segmental Doppler pressures and femoral artery waveform recordings. Preoperative and selective postoperative arteriography was routinely performed. Twenty-nine failures occurred predominantely in two groups, those with greater than 50% stenosis of the donor iliac artery and those with severe recipient limb outflow occlusive disease. Ten patients with normal outflow beds bilaterally associated with 10% to 50% stenosis of the donor iliac artery underwent successful femorofemoral reconstruction. Progression of donor iliac artery disease was seen in only two patients. Cumulative five-year patency was 74%. Operative mortality totaled three (3.8%). This study supports the use of femorofemoral bypass as a primary procedure when proper guidelines are used.