Background and Aims: Treatment of occlusive femoro-popliteal artery disease has changed during the last decade because of intensive development of endovascular technology. The aim of this study was to evaluate patient treated endovascularly or surgically for femoropopliteal atherosclerotic lesions and to assess perioperative and mid-term outcome. Material and Methods: This is a retrospective analysis of consecutive patients who had undergone prosthetic above-the-knee femoro-popliteal bypass or percutaneous transluminal angioplasty and stenting of superficial femoral artery stenosis or occlusion at Tampere university hospital, finland, between January 2007 and december 2009. patients who were alive were re-evaluated in 2010. primary and secondary patency and outcomes were assessed. Results: a total of 131 patients were treated; surgically 63 patients (69 procedures) and endovascularly 68 patients (74 procedures). The mean follow-up time was 17 months (sd ± 13 months). in the late follow-up visit, 8 (18%) patients in the bypass group suffered from claudication and 9 (20%) from critical limb ischemia. The corresponding figures for the endovascular group were 20 (36%) and 8 (20%), respectively. The primary patency was 60% at 2 years in the bypass group and 73% in the endovascular group (p = 0.092); the primary assisted patency was 62% versus 76%, respectively (p = 0.068). The secondary patency was 74% in the bypass group versus 79% in the endovascular group (p = 0.487). Conclusions: according to current results following TasC ii guideline, satisfied overall mid-term results can be achieved in the treatment of superficial femoral artery atherosclerotic disease.