Thirty-seven consecutive vein grafts to the infrapopliteal arteries are reviewed. Upper limb vein was used in each case, either for the entire graft (27%) or in combination with saphenous vein (73%). The grafts were inserted during a 10-year period and constituted 8.6% of the lower limb grafts carried out during this time. There was one postoperative death (2.7%). The patency rate at 3 years was 58 +/- 9.5% and at 5 years 49.1 +/- 11.5%. Indications for the use of upper limb vein in these situations are considered, and the results are compared with those obtainable with other materials. Upper limb vein can provide a satisfactory arterial substitute in the lower limb, and it may occasionally be the material of choice.