Over a 3-year period 21 patients underwent "in situ" saphenous vein by-pass graft for lower extremity arterial occlusive disease, all of them with critical ischemia for limb salvage. The proximal anastomosis was performed in all patients end to end to the first segment of the previously endarterectomized superficial femoral artery. The distal graft was taken to the popliteal artery below the knee in 8 cases, to the tibial-peroneal trunk in 4, to the posterior tibial artery in 3, to the peroneal artery in 3, to the anterior tibial artery in 2 and last a sequential posterior tibial-peroneal by-pass graft was performed. The perioperative mortality was nil. The immediate patency rate was 90.5%, while the cumulative patency rate at 36 months was 71.4% overall, 87.5% for the popliteal grafts and 61.1% for the infrapopliteal ones. If we consider that was successful for limb salvage in more than 80% and if the encouraging preliminary results of this technique will be confirmed at a longer follow-up, we believe that this technique could become the procedure of choice for limb salvage even in the high risk patients group.