Summary

In patients with critical infracrural disease, autologous saphenous vein grafting offers the best reported conduit patency and limb salvage rates but is only feasible in approximately 30% of patients due to the lack of available or suitable vein. In the absence of a suitable length of available vein, various composite grafting techniques have been explored with the aim to improve graft longevity, maximise native vein use and improve overall clinical outcomes, including limb salvage rates. We report a case of a 66-year-old man with critical limb ischaemia and a history of venous disease, where a complex composite sequential bypass graft combining both native vein and synthetic graft, incorporated into a novel intermediate anastomotic technique in a ‘diamond’ configuration, offered promising results in limb salvage. This case highlights the key steps and advantages in this novel technique.