# Long Femoropopliteal Lesions Challenge the Limits of Endovascular Technique: Contemporary Systematic Review and Meta-analysis

## TL;DR

This study reviews recent evidence on using endovascular techniques for treating long femoropopliteal artery blockages, showing varying success rates over time.

## Contribution

The study provides updated meta-analysis outcomes for endovascular treatment of long femoropopliteal lesions, including subgroup analyses.

## Key findings

- Endovascular treatment for long femoropopliteal lesions shows decreasing patency rates over time, with primary patency at 36 months at 42%.
- Secondary patency and freedom from revascularization also decline over time, with notable variation in outcomes based on subgroup analyses.
- The findings highlight the need to consider these results when making treatment decisions for patients with long arterial lesions.

## Abstract

Traditionally, patients with symptomatic femoropopliteal artery occlusive disease have been treated surgically. However, a growing body of clinical evidence has emerged supporting endovascular treatment in patients with long lesions. The objective of this systematic search and meta-analysis was to assess contemporary outcomes in patients undergoing endovascular treatment for long femoral-popliteal lesions.

An updated systematic search of Embase, including MEDLINE, identified relevant records published between January 2000 and March 2023 reporting a minimum of 1-year follow-up of endovascular revascularization in patients with mean lesion length ≥20 cm. A pooled meta-analysis was performed using a random-effects model for all longitudinal cumulative event rates. Subgroup analyses explored stratification by lesion length, intervention, study design, and outcome definition. Quality of evidence and risk of bias assessments were conducted.

A total of 28 records, 2338 limbs, and 2311 patients, were analyzed. The pooled cumulative event rates (95% CI) for primary patency were as follows: 0.85 (95% CI, 0.81-0.89), 0.67 (95% CI, 0.61-0.73), 0.48 (95% CI, 0.38-0.57), and 0.42 (95% CI, 0.33-0.52); secondary patency: 0.90 (95% CI, 0.85-0.93), 0.84 (95% CI, 0.77-0.89), 0.72 (95% CI, 0.64-0.78), 0.63 (95% CI, 0.52-0.73); and freedom from target lesion revascularization: 0.93 (95% CI, 0.89-0.96), 0.79 (95% CI, 0.74-0.83), 0.68 (95% CI, 0.62-0.73), and 0.63 (95% CI, 0.57-0.69) at 6, 12, 24, and 36 months, respectively. Select subgroup analyses showed clinically relevant variation in event rates.

This systematic search and meta-analysis provides important insight into the performance of endovascular revascularization in patients with long lesions. These findings will need to be considered as treatment decisions are made.