We performed routine postoperative surveillance of 124 consecutive in situ saphenous vein bypasses, using both ankle-brachial indices and color flow duplex imaging. Using a combination of low and high velocity criteria, color flow duplex identified 97% (37/38) of bypass and native artery inflow stenoses subsequently demonstrated by angiography, including 20 of 21 severe stenoses. A reduction in ankle-brachial index by greater than 0.15 identified 43% (16/38) of all stenoses, and only 10 of 21 severe stenoses. Revisional operations were performed in 30 bypasses for abnormalities detected by surveillance, resulting in a 3-year cumulative secondary patency of 87%. Color flow duplex is a superior technique for in situ bypass surveillance when compared to alterations in ankle-brachial indices. The identification of a bypass or inflow stenosis by routine surveillance and its subsequent operative treatment result in satisfactory long-term patency.