Abstract Fifteen cases of transinguinal lower extremity revascularization utilizing a direct anastomosis to the distal profunda femoris artery are reported. The results of this experience support the following conclusions: (1) The profunda femoris artery usually remains patent in cases of aortoiliofemoral arteriosclerotic occlusive disease. (2) This vessel can be dissected without damage to adjacent vital structures in sufficient length to permit vascular reconstruction. (3) In this selected group of patients, runoff into the distal collateral circulation from the profunda system is usually sufficient for maintenance of graft patency, relief of ischemia, and limb salvage. (4) Distal profunda femoris arterial revascularization appears to be a practical procedure that may be effectively applied to selected cases of peripheral arterial insufficiency.