Background: Critical limb ischemia is the most advanced stage of peripheral arterial occlusive disease. the prognosis is poor, with amputation rates up to 30 % and mortality up to 25 % after 1 year. Aim of the Work: to compare the results of primary bypass versus primary percutaneous transluminal angioplasty (PTA) in symptomatic superficial femoral artery (SFA) occlusive lesions in terms of complications, restenosis, symptom recurrence, re-interventions, major amputation and mortality. Patients and Methods: This prospective randomized comparative study was conducted in the Vascular Surgery Department at Al-Azhar University Hospitals. The study included 30 patients randomized into two groups (15 patients for Bypass surgery and 15 patient for angioplasty) suffering from SFA occlusion. Satisfying all the inclusion criteria mentioned below, after the clearance from the ethical committee was obtained, all patients were included in the study. Results: The present study was conducted on 30 patients, 19 males (63.33%) and 11 females (36.67%). . The early patency rate was 93.33% in the group with ‘Bypass', and 86.67% in the group with angioplasty. The late limb salvage rate in the group with ‘Bypass was 73.33 % while in the group with PTA was 66.66 %. Mortality occurred in two patients (13.3 %). Conclusion Endovascular intervention is the preferred method of revascularization in many scenarios; surgical revascularization is reserved for specific clinical scenarios and for cases where percutaneous therapy is not feasible or durable.