Two patients have been presented for whom the selection of a thoracic aorta to bifemoral artery bypass graft was necessary because the abdominal aorta was too compromised to be used as an outflow conduit. Both patients gained a most satisfactory result. The indications and contraindications for this procedure and its technique are cited. It is stressed that this operation should be selected for those patients for whom the more conventional bypass routes are not feasible or are hazardous. This merely gives the surgeon another option where circumstances are complicated. The surgical approach is usually straightforward and is associated with low morbidity and mortality. Patency rates and flow rates compare equally with the abdominal aortic to femoral bypass grafts.