Many surgeons prefer to use an autogenous saphenous vein rather than a synthetic prosthesis for arterial reconstructive procedures in the lower extremities.1,2 Because of the increased risk of infection about a plastic foreign body, the use of prostheses is especially hazardous when a cutaneous ulcer is present. Unfortunately, in some patients the saphenous vein is small as a result of heredity, superficial thrombophlebitis, or phlebosclerosis. If such veins are used for bypass procedures, the risk of early graft thrombosis is increased, probably because of low blood flow and relatively high resistance in the graft. Darling et al have noted that a saphenous vein measuring under 4 mm in external diameter contributes to early graft failure.2
Recently, we were confronted with the problem of revascularizing an ischemic limb in a patient with a very small saphenous vein and an open ulcer above the ankle. Prior experience with construction of