Purpose Femoropopliteal bypass grafting with venous conduit is a well described treatment modality for femoropopliteal segment peripheral arterial disease. A range of configurations exist for this procedure, and there is limited Australian data on the efficacy of reversed versus non-reversed and in-situ conduit. It is hypothesised that size mismatch between graft and artery may result in higher rates of proximal stenosis with reversed conduit. A single site retrospective cohort study was conducted to investigate this. Methodology All patients with infra-inguinal bypass at the Alfred between 2010 and 2015 were identified utilising the Australasian Vascular Audit (AVA) and included if they received a single vein graft. Outcome variables included proximal stenosis, reintervention, graft patency, graft failure, and major amputation. Patients were followed for 7 years. Results 171 patients were included. 56, 45, and 48 patients were lost to followup for stenosis, reintervention, and amputation analyses respectively. 34 out of 123 of the reversed group, and 19 out of 48 of the non-reversed group developed a stenosis over the study period, which produced a non-significant relative risk of 0.70. Reversed grafts had a significantly longer time to stenosis and reintervention, with a hazard ratio of 0.53 (p = 0.03) for stenosis and 0.55 (p=0.04) for reintervention. Conclusion In our single centre retrospective study, reversed bypass grafts demonstrate a significantly longer time to stenosis, which may have implications on determining an optimal conduit configuration selection strategy. Our study is limited by its retrospective design and loss to followup, and further prospective research is required to confirm our findings.