Prospective studies have shown that intensive vascular surveillance with echo-Doppler significantly improves arterial graft patency rate in the lower limbs although no conclusive data have demonstrated associated improvement in limb salvage. The lack of randomised controlled studies makes it difficult to advocate such intensive surveillance programmes to reduce limb loss after arterial reconstruction. Nevertheless, it appears that measures maintaining good graft patency in the lower limb have the best chance to be accompanied by improved life quality. Therefore, a fair protocol for graft surveillance should take into consideration early flow disturbances, intrinsic risks related to comorbidities and technical aspects of the graft material. Strict control of cardiovascular risk factors will greatly contribute to reducing the risk of late occlusive events by slowing or halting the evolution of the atherosclerotic process.