Indications for extra-anatomical shunts are defined on the basis of results of 51 consecutive operations. Axillo-uni or bi-femoral (AF) shunts (36 cases) and femoro-femoral (FF) shunts (15 cases) were performed in elderly men (74% over 60 years of age). These were patients in whom multiple affections (40 cases) or contraindications to direct local operations existed. The A-F were performed in either patients with chronic arteriopathies (2/3) or acute ischemic (6 cases) or infectious (4 cases) accidents. Immediate mortality (18%) was related to the age-group. Of the 47 limbs to be saved, 36 were preserved up to the 30th day. Long-term 2-year adjusted mortality was high (85%) because of the poor condition of the patients. The adjusted permeability level was 60% in survivors. The F-F were carried out in patients with either chronic arteriopathies or acute ischemic lesions. Immediate postoperative mortality was 13% and the early failure rate 25%. The long-term 4-year adjusted permeability level was 76%. All deaths were related to the atheromatous disease. These shunting operations remain complementary to conventional surgical procedures and should be reserved for cases such as those with obstacles to the direct reconstruction route or with generally very poor condition.