(1) An inverted Y graft to the proximal tibial arteries is described, and the limited clinical experience with this type of graft is presented. (2) The inverted Y graft provides a low-resistance high-low situation, which theoretically favors graft patency. (3) This clinical series confirms the value of bypass procedures to small, below-knee arteries in limb salvage situations. An excellent rate of success can be accomplished if meticulous surgical technique is used to implement the principles of small vessel surgery.