Abstract From my personal experience with a series of 227 extraanatomic bypasses, it is concluded that a high risk group of patients with multiple problems may have a reasonable alternative mode for limb salvage with extraanatomic bypass procedures. Axillo-bilateral femoral artery bypass grafts have a primary patency rate of 75 percent at the fifth year. With appropriate measures, net limb salvage can be accomplished in 84 percent of surviving patients at the fifth year. The result of a small group of patients with descending thoracic-aortofemoral artery bypass in this series was poor because of meager distal runoff and multiple previous operations. Axilloaxillary artery bypass grafts have shown an excellent long-term patency rate. A group of patients who underwent simultaneous axilloaxillary artery bypass and carotid endarterectomy have shown symptom-free long-term results with no subsequent stroke. This combined procedure showed no added neurologic morbidity. By proper application of extraanatomic bypass procedures, adequate palliation can be accomplished without major procedures in many patients who otherwise are high surgical risks.