Long-Term Outcomes of Femorofemoral Crossover Bypass Versus Endovascular Revascularization in Iliac Artery Occlusions: A Retrospective Study

<b>Objective</b>: The objective of this study is to compare the long-term outcomes of femorofemoral crossover bypass (FCOB) and endovascular treatment (ET) in managing iliac artery occlusions. <b>Methods</b>: The data of 200 patients with iliac artery lesions who were treated at a single center within 7 years were evaluated retrospectively. Of these, 82 (41%) underwent FCOB, and 118 (59%) received ET. Primary outcomes included patency, limb salvage, and survival rates, while secondary outcomes assessed complications, including wound infections and restenosis. Follow-up was conducted over a median of 4.98 years. <b>Results</b>: Primary patency (PP) rates after 3 years were 80% for FCOB and 88% for ET. Primary assisted patency (PAP) was 95% for FCOB and 93% for ET. Secondary patency (SP) was 97% for FCOB and 98% for ET. Both FCOB and ET achieved comparable long-term outcomes in limb salvage, 94% in both groups at 8 years. ET demonstrated advantages in shorter hospital stays (1.49 ± 2.51 vs. 8.21 ± 9.82 days, <i>p</i> < 0.0001) and lower perioperative complications, including transfusion rates (3.4% vs. 13.4%, <i>p</i> = 0.01226). However, FCOB exhibited lower restenosis rates (6.1% vs. 20.39%, <i>p</i> = 0.00441), despite a higher rate of reocclusion (19.5% vs. 6.8%, <i>p</i> = 0.00800). Survival rates at 8 years were 54% for FCOB and 67% for ET. <b>Conclusions</b>: ET is the preferred first-line approach due to its minimally invasive technique, shorter recovery time, and fewer complications. FCOB remains essential for patients with complex lesions or when ET is not feasible, offering durable long-term outcomes. Appropriate treatment selection should consider both the patient's condition and clinical and anatomical factors to optimize the best possible patient outcomes.