The absence of a distal arterial bed, early diagnosis of atherosclerotic lesions of the main arteries of the lower extremities, as well as the timeliness of adequate treatment leads to the progression of CLLI and the development of ischemia, threatening the loss of a limb, amputation and disability. In the absence of compensated circulation and the possibility of restoring the main blood flow in the ischemic lower limb, the functioning of the deep femoral artery (DFA) is determining in the preservation of the lower limb and improving the quality of life of patients. A prospective randomized study of the effectiveness of surgical treatment of 110 patients was conducted. Patients were divided into 2 equal groups depending on the surgical tactics: Group 1 (n=55) - patients with open surgical intervention (profundoplasty); Group 2 (n=55) - patients with endovascular surgical intervention (balloon angioplasty of the DFA with a drug-coated balloon). To assess the effectiveness of surgical treatment, the following parameters were assessed: patency of the reconstruction zone, preservation of the operated limb, dynamics of changes in the pain-free walking distance (PFWD) and ABI. In the immediate postoperative period, no significant difference was found in the indicators of patency of the reconstruction zone, preservation of the operated limb (p> 0.05), and no difference was found in the dynamics of the PFWD and ABI. However, it is worth noting that the incidence of postoperative complications was significantly higher (p<0.05) in the group with open surgery. In the late postoperative period, the reconstruction zone was considered passable in the presence of ultrasound indicators of laminar blood flow velocity <125 cm/s and DFA stenosis less than 50%. In the group of patients with profundoplasty, the patency of the reconstruction zone was 100%, in the group with endovascular treatment - 96%. The average figure of pain free walking distance in group 1 after 18 monthes was  973.7 ± 120.7 m. In the group with DFA angioplasty with a drug-eluting balloon 812.4 ± 97.6 m. The ABI indicators by the 18th month of observation in patients who underwent profundoplasty also characterized by a positive increase and were equal to 0.87 ± 0.06. In the TLBAP group, after 18 months average index of ABI is 0.72 ± 0.06. Based on the results of the study, it can be said with confidence that in patients with CLLI, if it is impossible to restore the main blood flow, revascularization through the deep femoral artery is the optimal surgical treatment option, allowing to slow down the progression of the disease and improve the quality of life of patients. Each of the methods has its own advantages and disadvantages, therefore, the choice of surgical treatment tactics should be based on a personalized approach to the patient's treatment, taking into account the history of the disease and the technical possibilities of performing revascularization.

Iago Sarkhanidze has completed his PHD at the age of 30 years from Petrovsky National Research Centre Of Surgery, Moscow, Russia. He is not only a practicing surgeon, but also a successful scientist. Has publications in Russian and international journals. He is also an active participant in international conferences. He is capable in treatment and diagnostic manipulations, conducts active medical work, and regularly participates in operations of varying degrees of complexity