Background: Management of superficial femoral artery flush occlusion using the ipsilateral antegrade approach is challenging. The study aimed to assess technical feasibility, patency, and limb salvage of ipsilateral antegrade angioplasty versus surgery for this lesion in patients with lifestyle-limiting claudications and critical limb ischemia. Methods: Between June 2015 and March 2018, 53 patients were randomized to either ipsilateral antegrade angioplasty (n = 28) or surgical bypass (n = 25). We included patients with Trans-Atlantic Inter-Society Consensus IIB, C, or D lesions, having a patent popliteal artery. Technical success, patency, limb salvage, and major adverse events were assessed during the 12-month follow-up. Results: The technical success was 100% and 89.3% in the surgical and endovascular groups, respectively (P = 0.238). At 12 months, the primary, assisted, and secondary patency rates were 72% vs. 64.5%, 78.2% vs. 74.7%, and 81.6% vs. 74.2% in the surgical versus the endovascular groups, respectively, without significant differences between both groups. Limb salvage was 88% vs. 92% in the surgical versus the endovascular group, respectively (P = 0.564). The length of hospital stay was longer in the surgical versus the endovascular group (6.24 ± 0.37 vs. 1.84 ± 0.19 days, respectively, P = 0.001). Local complications were higher in the surgical group (P = 0.046). Conclusions: Technical success, patency, and limb salvage of endovascular approach were comparable to surgical bypass. The endovascular approach had the advantages of reduced local complications and hospitalization.
