Efficacy and Safety of Endovascular Therapy with Stent Implantation Versus Endarterectomy in Common Femoral Artery Atherosclerosis: A Systematic Review and Meta-Analysis.

BACKGROUND

Common femoral endarterectomy (CFE) has historically been considered the treatment of choice for atherosclerotic disease, despite the limited level of evidence. This meta-analysis compared endovascular stenting and CFE regarding primary patency and key clinical and surgical outcomes.

METHODS

Eligible studies were identified through MEDLINE, Embase, and the Cochrane Library (International Prospective Register of Systematic Reviews registration CRD420251125586). Studies included patients with symptomatic atherosclerotic disease of the common femoral artery (Rutherford III-VI) treated with endovascular therapy with stent implantation (EVT with stent group) or standard endarterectomy. Articles published up to August 2025 were considered. The primary endpoint was loss of primary patency at 12 months. Secondary outcomes included major amputation, survival, freedom from reintervention, hospital length of stay, and wound complications. Meta-analyses and subgroup analyses were performed using random-effects models.

RESULTS

Seven studies (three randomized controlled trials and four cohort studies), including 1,179 patients, met inclusion criteria. Loss of primary patency favored CFE over EVT with stent (hazard ratio, 2.80; 95% confidence interval [CI], 1.36-4.26). At 12 months, endovascular treatment was associated with a 46% reduction in the risk of death, reaching statistical significance (odds ratio, 0.54; 95% CI, 0.38-0.77; P = 0.0008). Hospital stay and wound infection rates were higher in the CFE group.

CONCLUSION

Although CFE provides superior primary patency, the lower mortality, reduced hospital stay, and decreased wound infection associated with endovascular treatment support stenting as a satisfactory therapeutic option in selected patients.