Background: Critical limb ischemia (CLI) is a severe form of peripheral arterial disease (PAD) characterized by clinical findings of lower extremity ischemic pain at rest.The study aimed to discuss the better management of patients with critical lower limb ischemia. Patients and methods: A randomized control trails study was included 24 participants diagnosed with critical lower limb ischemia (CLI) due to Infragenicular lesions with mean age of 69.01±7.11 years and conducted at Vascular Surgery Department at Zagazig university Hospitals. Patients were divided equally into the endovascular therapy (EVT) group and the bypass surgical group. Follow up was done by the Rutherford recommended standards for reports dealing with lower extremity ischemia by using the life table and Kaplan-Meier survival curve. Results: The study revealed that the arteries that underwent dilatation were 7 anterior tibial arteries, 5 posterior tibial artery, 7 distal popliteal artery and 8 peroneal arteries. There was a significant difference of hemodynamic success among the studied groups. Additionally, there was no significant association of technical success between the studied groups. There were significant differences in limb salvage between the studied groups. The probability of artery patency in endovascular therapy group is higher than in bypass treatment in the 1st month, 2nd month and 4th month. Conclusion: Endovascular techniques are a viable treatment approach for limb salvage in patients with infrageniculate critical limb ischemia, and can be considered as a first-line approach in patients presenting with diabetes and/or tissue loss.