Background: Tibial artery bypass for limb salvage may be required in patients without adequate autogenous vein. The interposition of venous tissue at the distal anastomosis has been advocated to improve the results of prosthetic grafts to tibial arteries. Purpose of the Study: To study technical feasibility and results of Tibial by-pass using polytetrafluoroethylene (PTFE) with a distal vein patch (DVP), we record the results of this technique over 2-year were performed follow-up. Materials & Methods: From January 2012 to December 2015, 30 bypass grafts in 30 patients were performed with PTFE/DVP as the conduit. The technique was used for patients suffered critical limb ischemia with no available adequate vein as a conduit. Follow-up ranged from 1 to 24 months. Results are reported as primary patency or limb salvage (amputation rate). Results: Bypass grafts originated from the common femoral artery (8 [27%]), the superficial femoral artery (21 [70%]), and the external iliac artery (1 [3%]). Recipient arteries included anterior tibial (17 [57%]), posterior tibial (12 [40%]), and peroneal (1 [3%]). We recorded limb salvage rate of 70% in 24 months. We had 4 mortalities (13.33%) during the same follow-up period. Immediate techniqual success was 83.3% (25/30 procedure). The total incidence of major amputation was 9 cases (30%) at the 2 years follow up. Primary graft patency was 93.1 % at 1 month, 92.5% at 6 months, 88.4% at 12 months, and 63.33% at 24 months. Conclusion: The DVP technique allows PTFE bypass grafts to distal arteries with acceptable mid-term patency and limb salvage. This technique can be considered a safe & effective method for limb salvage in patients has no available vein conduit for bypass. Key Words: Distal bypass, Vein patch, PTFE Grafts.