The results of 101 in situ by-pass operations to the ankle and foot are given. Seventy-five percent of the patients had other arteriosclerotic manifestations and 55% were diabetics. Ninety-nine percent of the operations were limb salvage surgery. The accumulative secondary patency rate was 87% after one month and 65% after three years. The results did not differ from by-pass surgery to the crural arteries. The wound complication rate was 16% with an infection rate of 7% and the major amputation rate was 8% after one month and 10% after three years. The survival of this selected group of patients was lower than a group of sex- and age-matched controls. The long term results of this type of advanced by-pass surgery in limb threatening ischaemia are very satisfactory and should be a must in every vascular surgeon's armamentarium.