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In patients with severe lower extremity ischemia (ischemic necrosis or pain at rest associated with physical findings of peripheral arterial insufficiency), diabetes mellitus should not deter thorough arteriography and consideration of arterial reconstruction. Infrapopliteal bypass can produce prolonged limb salvage in diabetic patients in lieu of primary amputation.

Severe ischemia of the lower extremity in diabetic patients without runoff in the popliteal artery should not deter an aggressive diagnostic and therapeutic approach. Femorotibial or femoroperoneal bypass can effect limb salvage and avoid primary amputation if distal small vessel patency can be demonstrated by arteriography.