Clinical and hemodynamic results of isolated popliteal segment, tibial, and sequential bypass grafts were compared in a retrospective review. Results were good with vein grafts to either an isolated segment or infrapopliteal vessel, with five-year patency rates of 71% and 72%, respectively. Prosthetic grafts performed poorly in both groups, and sequential grafts appeared advantageous in such circumstances. Average ankle pressure increased 49 mm Hg following successful isolated segment grafts. Although less than with patent tibial or sequential grafts, improvement was sufficient to relieve rest pain in all instances and heal ischemic lesions or local amputations in all but four patients. If an adequate vein is available and a good tibial vessel exists, distal grafting may be elected, particularly if advanced ischemic lesions demand restoration of pulsatile flow to the foot. If such conditions are not present, isolated segment grafting will give highly satisfactory results.