Endovascular Therapy Versus Open Surgery for Common Femoral Artery Atherosclerotic Occlusive Disease: A Systematic Review and Meta-Analysis

The optimal revascularization strategy for common femoral artery (CFA) atherosclerotic occlusive disease remains debated. This systematic review and meta-analysis compared perioperative and long-term outcomes of endovascular therapy (EVT) and open surgery (OS). Methods: PubMed, Embase, Web of Science, the Cochrane Library, and ClinicalTrials.gov were searched through 15 March 2026 for comparative studies of EVT versus OS in CFA atherosclerotic occlusive disease. Outcomes included perioperative morbidity, wound complications, hospital stay, patency, reintervention, major amputation, and survival. Time-to-event data were pooled as hazard ratios (HRs), reported or reconstructed from Kaplan-Meier curves. Risk of bias and evidence certainty were assessed. Results: Eleven studies with 2835 patients were included. Compared with OS, EVT reduced 30-day morbidity (OR, 0.34; 95% CI: 0.26–0.44), wound complications (OR, 0.14; 95% CI: 0.09–0.23), surgical-site infections, lymphatic complications, myocardial infarction, and hospital stay (mean difference, −4.68 days; 95% CI: −5.49 to −3.86). Distal embolization increased after EVT (OR, 2.45; 95% CI: 1.28–4.70). Follow-up major amputation was higher after EVT in event-rate analyses (OR, 2.42; 95% CI: 1.19–4.93), although amputation-free survival was similar (HR, 1.01; 95% CI: 0.83–1.23). EVT had higher hazards of loss of primary patency (HR, 1.72), loss of secondary patency (HR, 2.03), and reintervention (HR, 1.51). Conclusions: EVT offers fewer early complications and shorter hospitalization, whereas OS provides more durable patency and fewer reinterventions. Given observational, heterogeneous evidence, treatment should be individualized.