The pathogenesis of foot ulceration in patients with diabe- tes involves the interplay of neuropathy, vasculopathy, and immune dysfunction. Autonomic neuropathy results in loss of pain sensation, decreased sweating, and the development of brittle skin, which pre- disposes these patients to foot trauma. As a result, the traumatized tissue progresses to necrosis and subsequent ulceration. Once an ul- cer is present, the vascular supply to the foot plays an integral role in healing. Foot ischemia in patients with diabetes may be attributed to atherosclerotic macrovascular disease and additional microcirculatory dysfunction. The following report will review the role of open bypass surgery addressing macrovascular problems for limb salvage. .