Introduction: Chronic atherosclerotic arterial disease of the lower limb have a progressive evolution, up to final clinical stages, when rest pain and trophic lesions are dominant. The treatment of election in these stages of disease is the revascularization treatment (endovas-cular, surgical and/or hybrid procedures).

Methods: A 59-year-old man had history of hyperten-sion, dyslipidemia and type 2 diabetes mellitus. He pre-sented with rest pain and trophic lesions of the left leg. Angiography of the left lower extremity demonstrated an chronic occlusion to superficial femoral artery. The patient underwent femoropopliteal bypass grafts with reversed saphenous veins. The short and medium-term evolution was favorable, but approximately 8 months after the bypass surgery, shows intermittent claudicati-on at short distances. Angiography of the left lower ex-tremity demonstrated an 98% stenosis at the proximal level of the bypass and 90% stenosis at the distal level of the bypass. The patient underwent percutaneous trans-luminal angioplasty with drug coated balloon.

Discussion: Peripheral artery disease and specifically superficial femoral artery disease, continues to rema-in a major health concern significantly affecting mor-tality, functionality, and quality of life. Endovascular treatment has increasingly become a more popular therapy over the past two decades. Many randomized controlled trials have reported the effectiveness of va-rious therapies including laser atherectomy, stent tech-nology, and drug-coated balloons over simple angio-plasty. Recently established guidelines and consistent definitions for clinical outcomes, coupled with the field taking steps towards direct comparisons, will be crucial to establish consistent care and meaningful gain in the treatment approach for these patients.

Conclusions: Critical limb ischemia is related to high possibility of limb amputation, severe complication and mortality. It is essential to achieve early recogni-tion and diagnosis. Revascularization in viable case as soon as possible plays the major role in limb rescue and complication prevention. Surgical intervention and en-dovascular treatment are effective choices with quick response.