Results of the autovenous by-pass in situ by distal combined arterial occlusion of femoral-popliteal and ankle arterial segments were analyzed. The main group consisted of 43 patients with diabetes mellitus and lower limbs ischemia grade IV in 81,4%. The comparison group consisted of 77 patients without diabetes and critical lower limbs ischemia in 84,4%. The 30 days by-pass patency was 90,5% in diabetic patients; whereas in the absence of diabetes mellitus the patency rate was 89%. There were no significant difference between two groups within the 2 years following the operation. After 3 postoperative years patients with diabetes showed poorer results: cumulative by-pass patency was 45,4%, limb preservation rate was 58,7%, whereas the relevant rates in the control group were 49,6 and 87,9%, respectively. The hemodynamic features of the by-pass make it suitable for the patients with diabetes mellitus and arterial occlusion by the diabetic foot syndrome.