Semi-closed, ex-situ, non-reversed or reversed autogenous vein grafting. A technique for femoro-distal arterial bypass. A technique is described for femoro-distal grafting in which vein is removed through very small incisions using the Mayo vein stripper, valves are ablated with the vein "ex-situ", and the graft is inserted non-reversed or reversed according to arbitrary criteria as to its diameter, with the distal anastomosis performed under tourniquet control. Early experience with 35 consecutive vein grafts showed no serious technical problems, satisfactory results and excellent patient acceptance. 