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The greater saphenous vein is assessed as part of the workup for femorodistal bypass surgery in our unit. The aim of this study was to determine whether the minimum internal diameter (MID) of the vein predicted graft patency and limb salvage in femorodistal bypass surgery, independently of the quality of the runoff. A consecutive series of 67 infrainguinal vein bypass grafts were performed on 62 patients with critical lower limb ischemia. All were followed for at least 1 year. The MID of the greater saphenous vein was calculated from preoperative saphenograms, and all of the arteriograms were scored for their runoff using an ad hoc method approved by the Society for Vascular Surgery. The cumulative patency of all vein grafts at 3 years was 59 +/- 7% (SE), and the limb salvage was 85 +/- 5%. All femoropopliteal bypass grafts were patent at 3 years if the MID of the vein was greater than 3.0 mm. The crural bypass patency was 66 +/- 12% for an MID greater than 3.0 mm and only 27 +/- 12% for an MID less than 3.0 mm. Every extra point on the runoff score increased the hazard of bypass failure by 16% (95% CI 1.0-34; p < .05). Vein diameter and runoff score were independent of one another (r2 = -.106). The MID of the greater saphenous vein is a major determinant of outcome in infrainguinal vein bypass surgery independent of the arterial runoff. [ABSTRACT FROM AUTHOR]