The authors' initial experience of angioscopic in-situ arterial bypass of 37 extremities reveals that angioscopy can be used to assist complete valvular ablation and precise location and ligation of tributaries of saphenous vein grafts, avoiding postoperative arterial-venous fistula and warm ischemic injury to grafts. Angioscopy is also used to perform intraoperative completion inspection of the grafts and anastomoses. The designed biocomposite graft and common ostium technique promotes the usage rate of the limited autogenous vein grafts and enlarges the diameter of grafts and blood flow through the distal anastomosis. Because of the above new series of procedures, the extremity salvage rate in this study was 34/37 limbs. During the follow-up period of 2-18 months, all anastomoses were patent. The preoperative ankle and toe pressure of 3.5 +/- 0.2 kPa and 2.0 +/- 0.1 kPa respectively rose to 5.4 +/- 0.1 kPa and 3.8 +/- 0.2 kPa postoperatively. We conclude that angioscopic in-situ arterial bypass surgery is of practical value and specially advantageous in lower extremity revascularization.