Background: The patients (pts) with critical limb ischemia (CLI) with combined diabetes mellitus (DM) and chronic renal insufficiency (CRI) can be a ���lethal or worst combination��� following infrapopliteal intervention. Methods: A total 33 pts with and without combined DM and CRI who underwent below-the-knee (BTK) intervention were enrolled for the study. CRI was defined as baseline serum creatinine more than 1.5 mg/dl. The major clinical outcomes of diabetic CRI pts (DM+CRI group, n=19) following below-the-knee (BTK) intervention were compared with those without DM and CRI (control group; No DM & CRI, n=14). Results: Baseline characteristics were similar between the two groups. Combined diabetic CRI pts had more calcific lesions (59.0% vs. 18.2%, p=0.002), smaller post PTA minimal luminal diameter (MLD, 2.13짹1.00mm vs. 2.99짹1.48mm, p=0.018) and thus less acute gain (1.70짹1.00mm vs. 2.93짹1.54mm, p=0.001). Despite of these worse immediate post procedural outcomes, post procedural ischemic complications were not different except there was a trend toward higher incidence of no reflow and acute thrombosis in control group. However, despite of the incidence of surgical ostectomy & debridement were significantly higher in the diabetic CRI group, the incidence of mortality, repeat PTA and major amputation were not different between the two group (Table). Conclusions: In this study, after successful BTK intervention, although the diabetic CRI pts had higher incidence of surgical intervention comprising ostectomy & debridement, however, the major hard endpoints were similar to those of control group, suggesting the efficacy and safety of successful BTK intervention for CLI pts.