The reperfusion of an ischemic limb in the absence of a suitable target artery remains a formidable task. The authors report a case of an ischemic limb in a patient whose distal arteries were identified intraoperatively as unsuitable for conventional revascularization. A distal arteriovenous fistula was created between the already arterialized in situ greater saphenous vein conduit and the inframalleolar superficial venous system of the foot. The flow through the superficial venous system salvaged the limb and continues to perfuse the foot 4 years postoperatively with resolution of rest pain.
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