Long-term results of bypass grafts for atypical coarctation of the thoracic aorta are presented. Six of the 13 patients with atypical coarctation were treated with long bypass from the descending thoracic aorta to the abdominal aorta. One of them had correction of right renal stenosis with a saphenous vein graft. Late clinical results of surgery (average follow-up time 4 years, 5 months and the longest over 10 years) were excellent, except for one patient who died 3 1/2 years postoperatively of acute abdomen. This experience suggests that atypical coarctation of the aorta can be treated satisfactorily by the long thoraco-abdominal bypass graft technique. If unilateral or bilateral renal artery stenosis is found simultaneously, renal revascularization is also necessary to obtain normalization of the blood pressures.