Sixty-two bypass grafts to the peroneal artery were performed at the University of Rochester Medical Center between 1984 and 1990. An autogenous conduit was used in 45 patients and a prosthetic conduit in 17 patients. Primary cumulative patency rates were 49% at two years and 30% at four years following operation. Limb salvage was achieved in 68% of patients. The two year cumulative patency rate was significantly better when the peroneal artery was of good quality arteriographically compared with those in which stenoses were present (75% versus 25%, p less than 0.05); in patients without inflow disease compared with patients with inflow disease (56% versus 11%, p less than 0.05); and in saphenous vein grafts compared with prosthetic grafts (55% versus 17%, p less than 0.05). The factors that did not influence patency were the presence of a direct peroneal collateral vessel filling a pedal vessel, age, sex, diabetes, and the size of the peroneal artery. The results of peroneal artery bypass in end-stage patients are dependent on the presence of adequate autogenous vein and a recipient peroneal vessel free of disease. Under these circumstances, the results of the procedure approach that of standard femorotibial reconstruction.