Purpose: Arterial bypass with common ostium distal arteriovenous fistulas (dAVFs) is one of the methods preserving the critical ischemic legs. We could successfully preserve legs with this procedures. Method: We reviewed nine cases that common ostium distal arteriovenous fistulas were constructed as adjuncts to distal tibial and peroneal artery bypasses in critically ischemic legs from Jan. 2000 to Dec. 2002. Result: In 9 case of this procedure, 6 grafts preserved and 7 legs could avoid amputation until our study termination. Conclusion: Although long term follow up results are needed to realize the final role of dAVF, we concluded that the dAVF seems to be an attractive option especially in these desperate patients by its excellent early patency rate. In this reports, recent 3 years' experience with a new use of an old modality for treating vascular ischemia is detailed.