JCS/JSVS guidelines recommend endovascular treatment as the first choice in the iliac region. However, femorofemoral crossover bypass (FF bypass), which is a non-anatomical bypass, is reported to be minimally invasive, with good patency. Moreover, it can be useful not only for claudication cases, but also chronic limb-threatening ischemia (CLTI) cases. We reviewed the significance of FF bypass in lower extremity arterial disease (LEAD) treatment, based on data from our institution.