Autogenous veins other than single-length greater saphenous vein were used in 150 operations to revascularize the extremities of 138 patients; three operations were for upper extremity ischemia and four were lower extremity reconstructions with lesser saphenous vein grafts. The remaining 143 bypasses were performed to revascularize lower extremities in 131 patients. Arm vein grafts were used in 102 operations, and 14 different combinations of vein segments were used to construct 41 totally autogenous composite vein grafts. Tissue necrosis or rest pain was the indication for 70% of arm vein bypasses; 52% of these grafts extended to an infrapopliteal artery. The 1-, 3-, and 5-year patency rates were 82%, 69%, and 60%, resulting in limb salvage rates of 93%, 91%, and 81%, respectively. Composite autogenous vein grafts resulted in a 1-year limb salvage rate of 79% in a select group of elderly patients with advanced arterial disease, poor runoff, and profound ischemia. Limb salvage was the indication for 93% of these operations; tissue necrosis was present in 71% while 80% required infrapopliteal reconstructions--37% to a peroneal artery and 29% to the ankle or foot. Successful limb salvage has been accomplished with alternative autogenous veins when the greater saphenous vein is missing or inadequate, dramatically reducing the use of prosthetic conduits in our practice.