Retrospective multicenter registry for endovascular treatment with newer devices in over 25‐cm femoropopliteal artery disease: A retrospective observational study

Abstract Background and Aims Endovascular therapy (EVT) is recommended in femoropopliteal (FP) lesions shorter than 25 cm by current guidelines; however, diffuse FP lesions remains challenging for EVT. The aim of this study was to investigate the efficacy of EVT with the latest devices for FP lesions longer than 25 cm. Methods This retrospective multicenter registry analyzed patients presented peripheral artery disease (PAD) having FP lesions longer than 25 cm who underwent EVT using the latest devices between 2017 and 2021. The primary outcome was restenosis 1 year after EVT. Results The present study enrolled a total of 504 PAD patients with 614 lesions undergoing EVT for diffuse FP lesions. The Kaplan–Meier analysis showed that the rates of freedom from restenosis and clinically‐driven target lesion revascularization were 79.3% and 82.4% 1 year after EVT, respectively. The multivariate Cox proportional hazards regression analysis showed that clinical features associated independently with restenosis risk were cilostazol use (adjusted hazard ratio, 0.49 [0.32–0.74]; p = 0.001), reference vessel diameter (RVD) (0.72 [0.58–0.89] per 1‐mm increase; p = 0.002), and P3 segment involvement (2.08 [1.33–3.26]; p = 0.001). The Kaplan–Meier analysis was conducted to compare the primary patency between cases with and without a small RVD, P3 involvement, and/or lack of cilostazol; any risk factors were related to a worse primary patency rate, compared with cases without risk factors. Conclusion In the current EVT era, the primary patency at 1 year was acceptable at 79.3% in patients with FP lesions longer than 25 cm. A small vessel and P3 segment involvement might be associated with a poor 1‐year patency rate after EVT, whereas cilostazol administration might contribute to reducing restenosis