Femorodistal vein bypass is regarded as gold standard for the treatment of limb threatening ischemia. Initially the procedure has been reported using saphenous vein (Rev Chir 70:206–35, 1951), mainly due to the lack of adequate vascular substitutes. Later vascular grafts have become available, and the enthusiasm to use autologous vein has faded, especially in difficult situations with no saphenous vein, although it is known that vein grafts perform superior to alloplastic vascular grafts.
A variety of methods gathered from literature have been collected and proven for their usefulness in everyday practice by the authors. We have a long-standing experience with femorodistal vein bypass using exclusively autologous vein allowing to critically evaluate current opinions on this topic.
The availability and technique of vein harvest of alternative vein for distal bypass is discussed, as well as the sequence of vein use, which is discussed in literature. Measures to increase vein availability, vein quality assessment, and methods for prevention of vein exhaustion are described.
More of 90 % of femorodistal bypass procedures can be accomplished with a vein graft even today. This requires a combination of dedication to bypass surgery, careful search for adequate vein, meticulous vein harvest, and attentive care to use vein resourced sensibly.