ObjectiveTo investigate the efficacy and safety of drug-coated balloons (DCBs) in the treatment of long-segment occlusive femoropopliteal arterial lesions.MethodsIt was a retrospective cohort study. The clinical data of 117 patients (122 affected limbs) who underwent successful interventional treatment for long-segment occlusive lesions of lower extremity arteriosclerosis obliterans in the Department of Vascular Surgery of Shanghai East Hospital from January 2018 to January 2022 were analyzed. All the lesions were TASC C/D grade lesions, with a mean lesion length of (21.6±7.1) cm. Among them, 65 patients (68 affected limbs) received conventional balloon angioplasty+ lower extremity artery stenting (control group), and 52 patients (54 affected limbs) underwent drugcoated balloon angioplasty (experimental group), with bailout stents implanted when necessary. The primary patency rates and freedom from target lesion revascularization (F-TLR) rates at 12 and 24 months after treatment were analyzed by Kaplan-Meier survival curves, and the occurrence of negative events such as death and amputation was observed.ResultsThe operations of all 117 patients (122 affected limbs) were successful. In the experimental group, 23 affected limbs (42.6%) had bailout stents implanted simultaneously. The Kaplan-Meier curves showed that the primary patency rates at 12 and 24 months were 61.76% (42/68) and 45.59% (31/68) in the control group, and 77.78% (42/54) and 62.96% (34/54) in the experimental group, respectively. The F-TLR rates at 12 and 24 months were 73.53% (50/68) and 55.88% (38/68) in the control group, and 83.33% (45/54) and 74.07% (40/54) in the experimental group, respectively; the differences between the two groups were statistically significant (both P<0.05). In the subgroup analysis of the experimental group, there was no statistically significant differences in the primary patency rates and F-TLR rates at 12 and 24 months between the drug-coated balloon alone subgroup and the bailout stent subgroup (primary patency rates: 70.96% (22/31), 61.29% (19/31) vs 86.96% (20/23), 65.22% (15/23), both P>0.05; F-TLR rates: 77.4% (24/31), 70.97% (22/31) vs 91.30% (21/23), 78.26% (18/23), both P>0.05).ConclusionDCB has a relatively good medium-term therapeutic effect in the treatment of long-segment arteriosclerotic occlusive femoropopliteal arterial lesions. For cases with poor immediate results of DCB treatment, the combination with bailout stenting is a feasible treatment approach.