The purpose of this study is to determine the role of renal failure (RF) in infrainguinal bypass graft outcome. From 1990 through 1996, 206 patients underwent 241 infrainguinal bypass grafts at two institutions. Thirty-three RF patients (42 bypasses) had a mean follow-up of 14.0 months and a mean age of 67.7 years, and 21 (64%) were male. Risk factors included hypertension (100%), diabetes (81.8%), and cardiac disease (75.8%). RF patients included 20 with end-stage renal disease (ESRD) and 14 with renal insufficiency (RI). One patient had RI during his first bypass and ESRD for his subsequent bypass. The major operative indication was limb salvage (90.5%). Total perioperative morbidity for ESRD was significantly higher than for RI and non-RF groups (P = 0.019). Early mortalities occurred in three ESRD, no RI, and seven non-RF patients. Life table analysis demonstrated no significant difference between primary patency (P = 0.56), secondary patency (P = 0.96), and limb salvage (P = 0.69) between ESRD and non-RF groups. However, there was an overall decreased survival rate in the ESRD group (P < 0.01). In conclusion, infrainguinal vein bypass grafting can be successfully performed in RF patients with comparable patency and limb salvage rates and therefore improve quality of life. However, perioperative morbidity was higher in ESRD and survival was significantly shorter for RF than for non-RF patients.