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Abstract This prospective randomized controlled study was conducted in Vascular Surgery Department, Tanta University, Egypt and Vascular Surgery Department, Leuven University, Belgium during the period from June 2015 to January 2018. The study included 53 patients diagnosed to have life style limiting IC or CLI (Fontaine stage IIb, III and IV) with angiographic evidence of chronic flush SFA occlusion, Trans- Atlantic Inter-Society Consensus (TASC II B, C and D) and at least patent popliteal artery below the knee as an outflow artery with in adequate G.S.V. (great saphenous vein).They were divided into two groups. The group (I) (endovascular therapy) included 28 while the group (II) (surgical bypass) included 52patients. Every patient was carefully assessed through: full history taking, complete general, local examination, laboratory investigation, duplex scanning and CTA. The clinical presentation was severe life-style limiting IC in 10 cases (35.7%) in group I and 11 cases (44%) in group II, and CLI in 18 (64.3%) cases in group I and 14 cases (56%) in group II. The clinical presentation had non-significant impact on patency rates. The most common medical co-morbid conditions were hypertension followed by hyperlipidemia in both groups. All risk factors had non-significant impact on patency rates There were no statistically significant differences between both groups in the baseline patients’ characteristics. |