Complementary distal arterio-venous fistula combined with deep vein interposition to improve infrapopliteal prosthetic bypass patency.

The rapid evolution of vascular surgical techniques over the last few years coupled with the availability of an adequate venous conduit has allowed a more liberal and successful approach to salvage ischemic limbs caused by advanced atherosclerosis. This aggressive approach can be exemplified by the construction of arterial bypasses to the terminal branches of tibial vessels. However, a significant number of patients will continue to face the threat of a major amputation because of insufficient amounts of vein(s) to perform a totally autogenous bypass to one of the infrapopliteal arteries.