Salvage of limbs affected by Buerger's disease has been a dilemma for surgeons. Palliative sympathectomy relieves vasospasm only in the early stages. Reconstructive procedures are usually not possible because graft patency rates are low. Limb amputation often is the only available management option. We used the omentopexy technique to salvage these limbs. Omentopexy was performed in 273 patients with sympathectomy failure in end-stage Buerger's disease. The technique of omentopexy is presented. The outcome has been analyzed with respect to improvement of clinical symptoms, ulcer healing, and angiographic and color Doppler studies. Of the 273 patients, 250 available for follow-up were followed for a mean of 7.5 years (range, 1-19.5 years). One- to 5-years follow-up (n = 110 cases) revealed good results in 94% of patients. Long-term follow-up (5-15 years; n = 140 cases) showed good results in 85% of patients.