The femoro-femoral cross-over graft is a good alternative to direct reconstructive vascular surgery in high-risk cases of unilateral iliac artery occlusion. The technique is simple and can readily be performed under local anaesthesia. A series of 21 patients is discussed briefly. Blood-flow measurements in seven patients confirmed the observation of other workers that a steal syndrome from the donor leg only occurred when the outflow tract in the donor leg was worse than in the ischaemic leg. Flow in the donor iliac artery was considerable increased. Four patients died in the observation period, one graft occluded three months after operation. There was no late failures.