Abstract Background: Aortobifemoral bypass (ABFB) remains effective and durable treatment option for aortoiliac occlusive disease (AIOD) and of cost-benefit in our country because of high cost of endovascular intervention. Purpose: To assess results of aortobifemoral bypass technique in the management of Trans-Atlantic Inter-Society Consensus II (TASC II) C and D lesions in aortoiliac segment. Patients and methods: This prospective study was conducted on 19 patients with symptomatic aortoiliac atherosclerotic TASC II C and D lesions. All patients were subjected to clinical evaluation, laboratory assessment, CT angiography scan, respiratory function tests and cardiac assessment by echo Doppler. Aortobifemoral bypass was performed for all patients who were divided into two groups A & B according to type of proximal anastmosis. Follow up period was 30 months. Results: All patients passed uneventful intra-operative course without technical failure; midline incision was done in 12 patients (63.2%). Proximal anastomosis was end to side in group A (13 patients (68.4%)) and end to end in group B (6 patients (31.6%)). Mean operative time and PO hospital stay was longer in Group B: (4.6±1.9 hours, range: 3.2-5.7) and (7.2±2.9 days, range: 6-9 days) respectively. Graft patency was 100%, 94.7% and 89.4% at 12, 24 and 30 months respectively. Conclusions: Aortobifemoral bypass is still a good option in aortoiliac occlusive disease especially complex lesions; TASC II C and D lesions as it has long durability and can be tailored to appropriately selected patients. So ABFB is still valuable technique in the field of vascular surgery.