Objective: This study evaluates the effect of arterial pedal arch quality on patency rates, freedom from major amputation, and wound healing in critical limb ischemia (CLI) patients with tissue loss undergoing distal bypasses. Materials and Methods: Retrospective analysis of the data of all CLI patients with tissue loss who undergone distal bypass between 2017 and 2021 at a single institution is done. Post-bypass pedal angiography is performed to classify patients according to the foot arch status into 3 groups; complete pedal arch (CPA), incomplete pedal arch (IPA), and no pedal arch (NPA). Patency, amputation free survival, patient survival, and wound healing rates are assessed at one-year follow-up and compared between the 3 groups. Results: A total of 88 patients had infra-popliteal (IP) bypasses (62 male; mean age, 74±9; hypertension, 85%; diabetes mellitus, 76%; smoking, 78%; dyslipidaemia, 71%). 49% of the distal bypasses originated from the popliteal artery (PA), 31% from the superficial femoral artery (SFA), and 20% from the common femoral artery (CFA). The most common outflow artery is the anterior tibial artery (39%) followed by the posterior tibial artery (36%). At 1-year follow-up, primary patency rates in the CPA, IPA, and NPA groups are 62%, 53%, and 45%, respectively (P-value = 0.41). Assisted-primary patency rates are 91%, 76%, and 83%, respectively (P-value = 0.424). Secondary patency rates are 100%, 88%, and 83%, respectively (P-value = 0.193). Overall patient survival at the end of the follow-up period is 81%. There is a statistically significant difference in terms of 12-months amputation-free survival among the three groups (CPA 100% vs. IPA 98% vs. NPA 83%, p-value = 0.015). Also, a statistically significant difference exists in wound healing rates between the study groups (CPA 81% vs. IPA 90% vs. NPA 61%, p-value = 0.039). Conclusion: Pedal arch status has a positive impact on major amputation free survival and wound healing in CLI patients with foot wounds undergoing infra-popliteal bypass grafting.