The use of an adjuvant arteriovenous fistula (AVF) in vascular procedures is controversial. The purpose of this study was to evaluate our experience with this adjunct in femorodistal bypass surgery. Patients who received a prosthetic femorocrural bypass with or without an AVF were studied (n = 56). Risk factors, Doppler and plethysmographic characteristics, and preoperative angiograms were analyzed. Of all prosthetic bypasses anastomosed to a single crural vessel, 75% received an AVF (AVF+, n = 44) whereas 25% did not (AVF-, n = 12). Preoperative ankle/brachial pressures and angiographic outflow scores in both groups were comparable. Successful revascularization doubled ankle/brachial pressure indices and tripled toe pressures. Bypasses with a maximum angiographic outflow score performed better than those with low scores (p <0.05). The overall patency rates after 1, 12, and 24 months were 87%, 62%, and 47%, respectively; an AVF did not influence these numbers although a trend favoring the use of a fistula was present at 1 year (AVF-, 54% vs. AVF+, 64%; p = 0.11). Moreover, 2-year limb salvage was not different between groups (AVF-, 75% vs. AVF+, 68%). The use of an AVF in prosthetic femorodistal bypass surgery does not improve rates of patency and limb salvage in the long term.