This study validates the use of an ultrasound three-dimensional reconstruction system to measure phantom and blood conduit geometry. Independently determined uniform and stenotic phantom dimensions are compared with reconstruction-based measurements. Lower extremity saphenous vein bypass graft reconstructions were performed to demonstrate clinical application. Uniform phantom independent and reconstructed volume correlation was high (r = 0.989), the average volume difference was 4.68 mm3 and the average area difference was 0.4 mm2. An in vitro 28% diameter reduction was detected. Stenotic bypass graft segment volume was 795 mm3; following successful angioplasty the volume increased to 1419 mm3. Advantages of this technique are its accuracy, the luminal information it provides and the absence of mechanical arm or acoustic transmitter limitations. We are exploring the possibility that measurement of luminal change over time may allow stenosis detection prior to hemodynamic disturbance, in an ongoing clinical saphenous vein bypass graft surveillance study.