Objective To investigate the effect of one stage arterialization of posterior tibial vein in treatment of peripheral arterial extensive occlusive disease. Methods Forty-six cases (56 limbs) of patients with peripheral arterial extensive occlusive disease were treated with one stage arterialization of posterior tibial vein. Results The symptom of pain disappeared right after one stage arterialization of posterior tibial vein in all patients . Skin temperature went up. The long-term results were satisfactory during the period of 3 months to 7 years follow-up, except two limbs were amputated and two limbs were reoperated with pedicle omental transplantation. Conclusion The technique of one stage arterialization of posterior tibial vein has advantages of one-stage procedure, various indications, little influence to venous return and rapid relief of ischemic symptoms.