Objective. To study the first experience of severe ischemia relief via bypass of tibial arteries and arterialization of the distal portion of small or great saphenous veins in patients with trophic disorders of the lower extremities (TASC II type D). Material and methods. There were 15 patients who underwent femoral-multi-tibial bypass surgery with arterialization of venous blood flow in 2016—2017. Patients received standard therapy recommended by clinical guidelines in postoperative period. Patients were followed-up during hospitalization and within 1 year after surgery. Results. Femoral-multi-tibial bypass surgery with arterialization of the venous blood flow of the foot is possible to save the limb. Early patency rate of the graft was 86.6%, after 1 year — 58.3%. Amputations were not required in 66% of patients. In our opinion, early postoperative critical ischemia in 5 (33%) patients with patent bypass graft was caused by abnormal arteriovenous bypass on the foot. Correction of pathological bypass was hampered by severe necrotic changes. Conclusion. Femoral-multi-tibial bypass surgery with arterialization of the venous blood flow of the foot is possible to preserve a limb in patients with trophic disorders, gangrenous changes of the foot and extended lesion (TASC II type D).