When endovascular is not the only answer

The debate between open surgery and endovascular therapy is far from over. This PVI 2025 session explores complex revascularisation scenarios where the choice of strategy requires careful consideration of anatomy, previous interventions and patient profile. 

Starting with common femoral artery disease, experts discuss surgical options after failed stenting and demonstrate why open repair remains feasible in most cases — challenging the idea that stenting should always be avoided in this challenging segment.

The discussion then moves to failed bypasses, highlighting situations where endovascular treatment may offer a valuable alternative, even when a suitable vein is available. 

Finally, the panel revisits the role of bypass in chronic limb-threatening ischaemia after BASIL-2, emphasising that while many lesions can be treated endovascularly, “endo first” is not always the optimal approach. 

Ultimately, the optimal revascularisation strategy is not defined by an “endo first” or “open first” philosophy, but by selecting the right approach for the right patient.