Background: In this study, we compared the results of distal surgical revascularization with medical therapy of amputation candidate diabetic patients with severe distal type peripheral arterial disease. Methods: A total of 40 patients who were referred to our clinic due to diabetic feet and critical limb ischemia between March 2008 and November 2010 were prospectively included. All of the patients were classified as Fontaine class 4. Twentyone patients (mean age 63.5 years) underwent infrapopliteal surgical revascularization, while 19 patients (mean age 67.9 years) received medical treatment. The median follow-up was 28 months (range, 16-47 months). Clinical findings, amputation records and graft patency rates were noted. Results: In the follow-up period, graft stenosis was seen in seven patients in the surgery group. The primary and secondary graft patency rates were 66.7% 80.9%, respectively in the surgery group. The mean time without limb loss was 42.3±2.7 months in surgery group, while it was 31.5±4.1 months in medically treated patients. Postoperative limb salvage rates were 90.5%, 85.7%, and 81% at 12, 24, and 30 months, respectively. Limb salvage rates of medically treated patients were 78.9% and 52.6% at 12 and 24 months, respectively (p<0.05). Conclusion: Amputation candidate diabetic patients may significantly benefit from surgical revascularization, despite the presence of distal peripheral arterial disease. Amputation rates and levels can be reduced and time without limb loss and limb salvage rates can be increased by surgical treatment.