Arm veins are the "second choice" conduit for femoro-distal grafting when the long saphenous vein is either not available or is unsuitable. However, obtaining a graft of sufficient length may be difficult if the forearm veins have been damaged by previous intra-venous cannulation. The harvesting of the upper arm veins separately may overcome the problem of insufficient length but entails a veno-venous anastomosis which is a potential source of both early and late problems. We have harvested both the upper arm cephalic and basilic veins in continuity and created a vein graft which is non-reversed proximally and reversed distally.