Evaluation of short-and mid-term outcomes after endovascular treatment of long-segment femoropopliteal lesions

Aim: To evaluate short- and mid-term clinical, hemodynamic and functional outcomes of endovascular treatment (EVT) using directional atherectomy combined with drug-coated balloon (DCB) angioplasty in long-segment femoropopliteal artery disease and to identify predictors of restenosis. Material and Methods: This retrospective, single-center study included 42 patients treated between January 2023 and December 2024 due to long-segment femoropopliteal occlusive disease. All patients underwent atherectomy followed by DCB angioplasty. Primary stenting was performed in 22 patients, while bailout stenting was required in 8 patients. All diagnoses were confirmed using pre-procedural computed tomography angiography (CTA). Follow-up was performed at 6 and 12 months using clinical evaluation and duplex ultrasonography (DUS). Restenosis was defined as >50% luminal narrowing or a peak systolic velocity (PSV) ratio of >2.5. Primary patency was analyzed using Kaplan–Meier survival analysis. Predictors of restenosis were evaluated using Cox proportional hazards regression. Results: The primary patency rates were 81% at 6 months and 69% at 12 months. Walking distance significantly improved from 85 meters preoperatively to 500 meters at 12 months (p<0.001). Marked improvement was observed in Rutherford classification. Diabetes mellitus, smoking and hyperlipidemia were significant independent predictors of restenosis. Minor access-site complications occurred in 3 patients (7.1%), all of which resolved conservatively. Conclusion: EVT provides favorable short- and mid-term outcomes in patients with long-segment femoropopliteal artery disease. Nevertheless, mid-term restenosis remains a major limitation. Comprehensive management of modifiable risk factors combined with the use of advanced endovascular devices is essential for improving long-term patency and clinical success.