In a severe, diffuse arterial occlusion model of canine hind-limb ischemia, both distal arteriovenous fistula (AVF) and arteriovenous end-to-side anastomosis (AVA) were evaluated as potential methods of revascularization. AVA reversed or minimized both hemodynamic and metabolic indices of ischemia; AVF did not. After AVA segmental blood pressures at the thigh returned to normal, and those at the calf returned to 0.8 from an ischemic level of 0. Both postocclusion toe pulse reappearance times and the toe pulse volumes partially returned toward normal. IN addition, gastrocnemium intramuscular Po2 returned from an ischemic level of 5.3 to 45.5 mm Hg, compared to a control normal of 47.6 mm Hg. Muscle surface pH returned to 7.40 from the ischemic level of 7.06. AVA appears to offer an approach to the treatment of severe, diffuse arterial disease that would utilize the distal venous tree to transport blood to the capillaries for the support of adequate tissue nutrition.