To determine if the indications and numbers of the axillofemoral bypass have changed, a retrospective analysis was performed of all patients undergoing axillofemoral bypass over the past two decades. Group A (1980-89) and group B (1990-99) were compared using demographics, comorbid illness, perioperative outcomes, and indications for operation. There were 33 extraanatomic bypasses performed in group A and 24 extraanatomic bypasses in group B. The average age in both group A and group B was 69 years. Males comprised a higher percentage in group B (75%) than in group A (55%). The percentage of smokers was roughly equivalent (group A 76%, group B 71%). Coronary artery disease was more prevalent in group A (85%) than in group B (63%). Diabetes mellitus was also more common in group A (33%) than in group B (21%). All of the grafts in group B were composed of PTFE and there were 2 early (30 day) failures (6%). There were no perioperative deaths, strokes, or myocardial infarctions. At our institution, the axillofemoral bypass is now reserved almost exclusively for the treatment of graft infections and rarely for primary limb ischemia. This evolution is a reflection of the increase in interventional techniques used to improve inflow in high-risk patients who require revascularization.