In order to evaluate the effect of angiographic run-off upon peroneal artery autogenous vein bypass patency and subsequent limb salvage, 53 autogenous vein peroneal artery bypasses performed for ischemic tissue loss were reviewed. All preoperative angiograms were evaluated according to three separate angiographic scoring systems that previously had been designed to quantify the severity of runoff resistance. None of the three scoring systems predicted either early bypass occlusion and/or major amputation. The cumulative 18-month primary patency and 24-month secondary patency rates were 71% and 90%, respectively. The 24-month limb salvage rate was 81%. Initial and intermediate-term salvage of limbs with ischemic tissue loss can be achieved by peroneal artery bypass. Angiographic scoring systems were poor predictors of bypass failure or major amputation.