OBJECTIVE To clarify the clinical features of chronic arterial occlusive disease in which the main lesion occurs in the popliteal artery (OPA). METHODS This was a retrospective study with a follow-up of 1 to 163 months. METHODS A department of surgery in a university hospital. METHODS Fifty-six patient who underwent tibioperoneal bypasses: 31 patients with OPA, and 25 with an extensive occlusive lesion from the femoral to popliteal artery (OFPA). METHODS All bypasses were performed using reversed saphenous veins under tourniquet ischemia. METHODS The background of the patients and the surgical results, including long-term patency and postoperative arteriographic findings. RESULTS Buerger's disease occurred most commonly in the OPA group (49%) and arteriosclerosis obliterans occurred most commonly in the OFPA group (64%). The 3-year primary and secondary cumulative patency rates of the grafts for OPA were 72% and 85% respectively, and were comparable with those of OFPA. Arteriographic analyses carried out in the follow-up period revealed no occlusive progression in the inflow artery. CONCLUSIONS Popliteal-distal bypass is a reliable procedure in selected patients with OPA.