An arterial bypass graft using a person’s own vein for the graft is the most durable means to treat severe peripheral artery disease when the blockage is below the level of the groin. Graft surveillance is of proven benefit in improving graft patency at least in the first year after arterial bypass surgery. The testing frequency should be individualized to the patient, type of arterial bypass, and duplex scan findings. Graft evaluation can include clinical assessment for new or changes in limb ischemia symptoms, measurement of ankle or toe systolic pressure, or both, and duplex ultrasound imaging of the bypass graft, which in the early postoperative period is predictive of the subsequent need for bypass graft revision. Surveillance intervals can vary from every four months during the first year after surgery, every six months the next year, then annually.