Summary Emphasis is placed on utilization of the profunda femoris artery for revascularization of the lower extremity in patients with advanced aortoiliac, femoropoliteal, and popliteal arteriosclerotic occlusive disease. The profunda femoris artery is usually spared from atherosclerotic disease except at its orifice from the posterior wall of the common femoral artery. It seems to be the last vessel to occlude with progressive atherosclerotic disease of the lower extremity. Increase in flow from aorta to the profunda femoris artery by bypass grafting has resulted in an extremely high rate of limb salvage in patients with far advanced arteriosclerotic obstructive disease. It is worth considering in those patients with severe symptoms and poor runoff who are usually refused any surgical therapy at all.