Sympathectomy and thrombo-endarterectomy have been largely unsatisfactory in the treatment of patients with arterial insufficiency of the lower extremities. In this paper the results are analyzed of a large experience with the use of lyophilized arterial homografts to bridge occlusive lesions below the aortic bifurcation. The criteria for selection of patients for operation, the simplified procedure of end-to-side by-pass of the obstruction, and the excellent results in 145 operations are presented.