PURPOSE: To evaluate the efficacy of surgical treatment for multilevel aortoiliac occlusive diseases, we retrospectively analyzed 89 recent cases surgical treatment was used. METHODS: From March 1992 to July 2001, we performed 62 aortobifemoral bypasses and 27 other bypasses as primary procedures. We analyzed surgical indications, combined diseases, cardiac risk assessment, type of occlusion, treatment modalities and cumulative patency rate. RESULTS: In 59 aortobifemoral bypasses, 8 end-to-end and 51 end-to-side proximal anastomoses were performed. Adjuvant PTA, with or without stent before bypass operation, was performed in 13 cases. Types of occlusions were Rutherford type I in 18.0%, type II in 20.2% and type III in 61.8%, respectively. Associated diseases were hypertension, diabetes, cerebrovascular accidents, and myocardial infarction in order of frequency. Mean follow-up duration was 36.4 months. Cumulative patency rate by life table analysis was 77.5%. Leg or foot amputations were performed in 13 cases (14.6%) after bypass operations. Two cases of amputation were performed after 13 simultaneous infrainguinal bypasses, and in 4 cases after staged infrainguinal bypasses. Operative mortality occured in 4 cases (4.5%). CONCLUSION: Aortobifemoral bypass remains one of the most durable and effective arterial reconstructions, for extensive aortoiliac occlusive diseases in young patients with low operative risk. Simultaneous infrainguinal bypass is preferred in patients with poor distal run-off.