Mesenteric artery bypass originating from the supraceliac aorta (antegrade bypass) has been the standard orientation of visceral artery bypass grafts. Retrograde bypass, in which the bypass originates from the iliac arteries, has not been as widely accepted. The purpose of our study was to compare the results of these two types of bypass in a similar population. We retrospectively reviewed the records of patients undergoing mesenteric artery bypass at two tertiary care medical centers (UCLA Medical Center, Beth Israel Deaconess Medical Center). Between February 1992 and January 2001, 37 patients underwent 39 mesenteric bypass procedures. The choice of bypass orientation (antegrade versus retrograde) was determined by the individual surgeon. Chart review, duplex ultrasonography, and/or telephone interviews were used to assess symptom-free survival. Actuarial analysis was completed using Kaplan-Meier survival estimates. From this assessment we were able to determine that symptom-free survival of patients undergoing retrograde mesenteric bypass is similar to that seen in antegrade bypass. Primary retrograde bypass is a valid option for patients undergoing mesenteric bypass.