OBJECTIVES: To compare the efficiency of three strategies for the stenosis of the femoropopliteal sector treatment: bypass surgery (BP), percutaneous transluminal angioplasty with selective stent insertion (PTA/S), and percutaneous transluminal angioplasty with selective stent insertion followed by possible bypass surgical reintervention (PTA/S/BP). METHODS: An economic evaluation was developed by implementing a Markov model with three main branches representing each of the strategies studied. We used a time horizon of 30 years, discounting 3% to costs and effects. The measure of effectiveness was years of quality-adjusted life (QALYs).  Probabilistic and multivariate sensitivity analysis was performed by using Monte Carlo (MC) methods. Acceptability curves and the expected value of perfect information were calculated.    RESULTS: Taking into account the results from MC simulations, the PTA/S alternative is the most expensive and less effective (€ 24,581 and 6.857 QALYs), but attending to small differences and the large variability on results between alternatives, these results are not conclusive. The least costly alternative is PTA/S/BP (€ 18,351), with an effectiveness of 7.049 QALYs. PTA/S/BP shows higher effectiveness than PTA/S, but lower effectiveness than BP (7.281 QALYs). The cost of the BP alternative is € 24,056. PTA/S/BP and BP alternatives show higher probabilities of being efficient alternatives. If the willingness to pay is € 30,000/QALY, opportunity cost of implementing PTA/S/BP would exceed € 15,000 per patient treated.  CONCLUSIONS: Although the results of effectiveness identified PTA/S/BP as the most efficient alternative for a willingness to pay less than € 40,000/QALY, the probability of making a proper decision is only about 50%. This situation, together with the high opportunity costs, encourages the development of new clinical trials or observational studies in our environment in order to remove uncertainty over the results.