Outcomes of Peripheral Endovascular Interventions Involving Common Femoral Artery: A Report from the XLPAD Registry

There is limited data on whether the presence of downstream arterial disease influences outcomes following endovascular revascularization of common femoral artery (CFA). Herein, we aim to compare outcomes of endovascular intervention for symptomatic peripheral artery disease in patients with isolated CFA versus patients with multilevel disease involving the CFA and other infrainguinal arteries. A total of 334 patients were retrospectively analyzed from the XLPAD Registry (NCT01904851) from 2016 to 2024. Primary outcome was 1-year major adverse limb event (MALE). Of the 334 patients, 143 (42.8%) underwent endovascular intervention for isolated CFA lesions and 191 (57.2%) for multilevel disease. Mean age was 69.0 ± 10.5 years with 35.6% females. Chronic total occlusion (21.0% vs. 42.9%; p<0.001), diffuse lesion (19.6% vs. 31.9%; p=0.011), and severe calcification (18.9% vs. 33.0%; p=0.004) were more common in the multilevel disease group. Procedure time was shorter in the isolated CFA group (82.2 ± 39.6 vs. 124.1 ± 69.6 minutes; p<0.001). Technical success (93.0%) and procedural success (91.2%) were similarly high in both groups with overall low peri-procedural complications (2.4%). At 1-year, there was no significant differences in all-cause mortality (4.2% vs. 5.2%; p=0.7) or bleeding events (1.4% vs. 2.1%, p> 0.9). The multilevel disease group had a trend toward a higher rate of 1-year MALE compared to isolated CFA (plog rank= 0.07). In conclusion, infrainguinal disease is common in patients undergoing CFA treatment, indicates greater atherosclerotic burden, and is associated with a trend toward worse limb outcomes, suggesting that treatment success depends on the extent of downstream disease.