Femoral-to-femoral bypass reconstructions were first described by Vetto in 1962. It is a low-stress, low-risk procedure with excellent long-term results. Its use need not be confined to high-risk patients with tissue necrosis; it can be offered to moderate-risk patients with unilateral disease and incapacitating claudication. Studies in the noninvasive vascular laboratory assist in the preoperative selection of patients as they determine if the iliac artery on the asymptomatic side is capable of acting as an inflow vessel. Noninvasive evaluation and monitoring at regular intervals after operation allow for early detection and correction of new disease.