The aim of the present study is to analyze the long term results of primary composite bypass grafts comparing them to PTFE and vein grafts and moreover to show any difference between patency and limb salvage rate between sequential and straight composite bypass grafting for chronic critical limb ischemia. Between 1980 and 1996, 568 primary bypass procedures were performed and analyzed. A saphenous-vein graft was used in 428 procedures, a PTFE graft in 44 and a composite PTFE-saphenous vein graft in 96. Twenty one of these were sequential and 75 straight, whereas, 36 were below the knee and the 60 extended more distally. Mean follow up was 46.5 months. Five year primary and secondary patency and limb salvage rates were compared by life table analysis. Five year patency for composite grafts were 58%, for saphenous vein grafts 74%, while secondary patency was 75% and 82% respectively (p<0.05). The five year limb salvage rate was 80% for composite grafts and 88% for saphenous vein grafts (p>0.05). The primary and secondary patency and limb salvage rate for PTFE grafts was 24%, 31% and 40% respectively. Straight composite grafts showed a five year primary patency of 46%, whereas, when adding the patency for sequential composite grafts the patency was 53%. Additionally, the 3year primary patency of sequential composite grafts was similar to that of saphenous vein grafts for the infrapopliteal bypasses (81.2% versus 81.7%). In conclusion, composite bypass grafting is an acceptable alternative to saphenous vein bypass grafting and moreover, sequential composite bypass offers similar to all autogenous bypass 3year primary patency for the group of patients who need infrapopliteal distal revascularization, but lower 5year primary patency. These results can serve as an historical cohort for the nowadays and the future extended use of endovascular techniques to treat critical limb ischemia.