B AC K G R O U N D We emphasized our experiences in distal bypass surgery for salvaging extremities in the patients who have critical leg ischemia and who considered to have poor runoff angiographically. M ET H O D S T otally, 20 pat ients und e rwent per i pheral bypass surgery at inf r apopl it eal level in order to salv age the ext r emity at risk for crit ical isch em ia in the Dep a r tment of Cardiovascular Surgery, GATA Haydarp asa Training Hosp ital betw een 2000 and 2005 were enr o lled to the study. Patients had stage IV dis e ase acc o rding to Font ain class if ic at io n and ang io graphically ineff e ct ive run-off at distal art er ia l segments. Long-term outc omes foll owing surgery wer e eval u ated by Doppler ult r ason o graphy and ang io graphy. R E S U LT S Color Doppler ult r as on o graphy, ang io graphy and physical exam in at ion were used to assess the patency of the grafts and the status of the ext r emity. The pat ients were foll owed up aver agely 27.3±14.7 months (1-60), and the c um ul at ive perc e nt ages of graft patency and extremity salv age were 45% and 55%, resp e ct ively. CO N C L U S I O N S In extremity salvaging surgery, successfully results may be achieved by infrapopliteal bypass. Time is a very crucial factor, and patient may lose his last chance in case of rapidly progr e ssing necr ob i osis, necr osis, and gangrene. We believe that a quickly performed distal arterial exploration will not only give no harm to the patient, but also provide an opportunity to save the limb.