AbstractThis study assessed the effect of femoro‐femoral bypass on penile perfusion and impotence. Twelve patients with femoro‐femoral grafts had Doppler pressure measurements and penile/brachial indices (PBI) recorded at both dorsal penile arteries, first with the graft open and then with the inflow portion of the graft temporarily occluded by manual external compression.Doppler pressure measurements and PBI did not change significantly in the dorsal penile artery on the donor (inflow) side of the graft when the graft was temporarily occluded. Patients who were potent both pre‐ and postoperatively (n ‐ 5) had no significant change in pressure or PBI on the recipient (outflow) side of the graft with graft occlusion. In those patients who experienced reversal of impotence following bypass (n = 4) the mean dorsal penile artery pressure on the recipient side decreased from 101 mmHg with the graft open to 30 mmHg with the graft occluded (P<0·05).Review of arteriograms revealed that patients most likely to experience increases in penile perfusion have either (a) recipient side common iliac artery occlusion and a patent internal iliac system which is perfused in a retrograde fashion or (b) recipient side proximal internal iliac occlusion with well‐developed collateral circulation between the profunda femoris and the distal internal iliac arterial systems.Femoro‐femoral bypass can increase penile perfusion and alleviate vasculogenic impotence in selec