Experience with fifty-three femorofemoral grafts performed as the initial operation for iliac occlusive disease over a ten year period is reviewed. There was one operative death (2 per cent). There were two early and three late graft failures, for a five year cumulative graft patency rate of 80 per cent. Of the twenty-eight patients in whom the femorofemoral graft was performed for limb salvage, the five year cumulative limb salvage rate was 91 per cent. During the follow-up period, two grafts were converted to axillobilateral femoral grafts because of recurrent symptoms of claudication caused by progression of disease in the iliac system from which the femorofemoral graft originated. All other patients with patent grafts have had satisfactory relief of symptoms throughout the follow-up period.