For below-knee leg arterial bypass, autogenous saphenous vein graft is a well- known bypass conduit of choice. With increasing cardiovascular bypass procedures, autogenous vein graft is not always available for leg artery bypass secondary to various causes. To improve prosthetic graft patency, distal anastomotic vein cuff or patch can be performed as adjunctive procedure for leg artery bypass. PURPOSE: We attempted to determine the effects of distal anastomotic autogenous vein cuff or patch on prosthetic bypass graft patency. METHOD: Among the patients with below-knee prosthetic bypass, 22 bypasses with distal anastomotic vein cuff or patch (Group I) and 10 bypasses without vein cuff or patch (Group II) were compared retrospectively. All grafts material were 7 mm externally supported ringed PTFE graft. Clinical features and bypass procedures, frequencies of concomitant inflow procedure, emergent operation, thrombus removal from native artery and redo bypass were compared between 2 groups with similar results seen. However, the levels of distal anastomosis were tibioperoneal in 77.3% and below-knee popliteal artery in 22.7% in group I while it was all below-knee popliteal artery in group II. RESULT: In group I, primary (secondary) patency rates at 12 months and 36 months were 45.8% (60.5%) and 32.1% (40.9%), respectively, by Kaplan Meier method. These rates were 23.3% (45.7%) and 23.3% (34.3%), respectively, in group II. But these differences in patency rates did not meet statistical significance. CONCLUSION: Despite considering the weak power or our retrospective study, we would like to conclude that vein cuff or patch at distal anastomosis of prosthetic graft can improve graft patency, though not meeting statistical significance. This adjunctive procedure makes prosthetic grafting feasible even in the very small crural arteries.