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In order to compare the outcome and costs of femorodistal grafting in diabetic and nondiabetic patients presenting with critical limb ischaemia we analysed a consecutive series of 109 femorodistal bypasses, 38 (35%) performed on people with diabetes and 71 (65%) on non-diabetic patients. The same aggressive revascularization policy was used in both groups with the decision to operate based on the presence of a calf or foot vessel on preoperative intra-arterial digital subtraction angiography (IADSA). Data were collected prospectively and the median follow-up was 15.4 months (range 0 to 42 months). There were no significant differences in 30-day (5.3% vs 4.2%) and in-hospital mortality (13.2% vs 14.1%) between the two groups. Life table curves at 3 years in diabetic and non-diabetic patients showed 48% vs 60% survival, 76% vs 72% knee salvage, 45% vs 56% limb salvage, and 38% vs 47% secondary patency. Although there was a trend for diabetic patients to perform less well, there was no statistically significant difference in these outcome measures. In cost comparison the only significant difference was found in the total hospital cost, which was Pounds 9181 in diabetic, compared to Pounds 6350 in nondiabetic patients (p = 0.026, Mann-Whitney). However, this cost was significantly less than that of primary amputation in either group (Pounds 15500 and Pounds 12040, respectively). Femorodistal reconstruction in both diabetic and non-diabetic patients, whenever feasible, is a cheaper option than primary amputation, even though vascular surgery may be more expensive in people with diabetes.