Background: Revascularization is central to the management of advanced peripheral artery disease. Endovascular therapy offers a minimally invasive approach, while surgical bypass remains important for complex lesions and durable limb salvage.

Objective: To compare clinical outcomes of endovascular and surgical revascularization in patients with symptomatic lower-extremity peripheral artery disease.

Methods: A prospective observational study included 620 patients undergoing revascularization between January 2020 and December 2024. Patients were treated with either endovascular intervention or surgical bypass based on anatomy, comorbidity, and multidisciplinary vascular team decision.

Results: Technical success was 96.4% in the endovascular group and 94.8% in the surgical group. One-year primary patency was higher after surgery, while endovascular therapy showed shorter hospital stay and fewer early complications. Limb salvage rates were comparable between groups.

Conclusion: Endovascular therapy provides lower early morbidity and faster recovery, whereas surgical revascularization offers superior long-term patency in selected patients with complex disease. Individualized treatment selection remains essential.