The correct treatment strategy for complex atherosclerotic femoropopliteal lesions remains still a challenge. The ideal treatment is the revascularization of the limb to provide adequate blood flow through a vein graft. In the absence of a vein graft for these revascularizations a prosthetic graft can be used but with poor outcomes. In this study, we demonstrated that in the absence of a vein graft revascularization with endovascular procedures such as balloon angioplasty with or without stenting offer better results in many clinical outcomes rather a femoropopliteal bypass with a prosthetic graft.