477 ORIGINAL ARTICLE Endovascular or open surgical treatment of high-risk patients with infrainguinal peripheral arterial disease and critical limb ischemia Dragan Totić 1 , Vesna Ðurović Sarajlić 1 , Haris Vranić 1 , Amel Hadžimehmedagić 1 , Nedžad Rustempašić 1 , Muhamed Djedović 1 , Haris Vukas 2 , Alen Ahmetašević 1 1 Clinic for Cardiovascular Surgery, University Clinical Centre, Sarajevo, 2 Department of Surgery, Cantonal Hospital, Zenica; Bosnia and Herzegovina Corresponding author: Dragan Totić Clinic for Cardiovascular surgery, University Clinical Centre Bolnička 25, 71000 Sarajevo, Bosnia and Herzegovina Phone/fax: +387 33 29 77 05: E-mai: dragan.totic@gmail.com ORCID ID: https://orcid.org/0000–0002- 8929-5428 Original submission: 13 February 2020; Revised submission: 21 April 2020; Accepted: 18 June 2020 doi: 10.17392/1143-20 Med Glas (Zenica) 2020; 17(2): 477-484 ABSTRACT Aim To determine preferable type of treatment in our clinical cir- cumstances by following two groups of patients with critical limb ischemia (CLI), who were treated endovascularly and surgically. Methods Research was carried out in the form of a prospective study of 80 patients with CLI and Trans-Atlantic Inter-Society Consensus (TASC) C or D type of arterial disease, with Ame- rican Society of Anesthesiology (ASA) class III risk, who were randomly divided in two groups as per the treatment they recei- ved, surgical and endovascular. Patients were followed during 28 months using clinical examination and Duplex Ultrasound (DUS) in accordance with prescheduled control visits. Results There was a statistical difference between surgical and en- dovascular group in two years patency (82.5% vs. 55%; p=0.022) but it did not result in the difference in amputation free survival (AFS) (95% vs. 85%; p=0.171) or two-year freedom from major adverse limb events (MALE) (87.5 vs. 77.5; p=0.254). Also, the- re was no difference in the overall survival of patients (100% vs. 97.5%; p=0.317). Conclusion Initial endovascular treatment is a preferred form of the treatment for selected patient population. Key words: amputation-free survival, endovascular procedure, infrainguinal bypass, patient survival critical limb ischemia, endo- vascular, peripheral arterial disease, surgical