Work

A Systematic Review and Study-Level Meta-Analysis Investigating the Association Between Pre-endovascular Intervention C-Reactive Protein Levels and Femoropopliteal Artery Restenosis

Year: 2026

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: BACKGROUND: Restenosis in previously treated femoral or popliteal arteries remains a clinical issue, leading to repeat procedures, and major adverse limb events. Elevated pre-endovascular intervention levels of C-reactive protein (CRP), a marker of systemic inflammation, have previously been associated with coronary restenosis; however, its association with femoropopliteal artery restenosis is unclear. We conducted a systematic review and study-level meta-analysis to assess the association between pre-endovascular intervention CRP levels and femoropopliteal artery restenosis. METHODS: Online databases of PubMed, EMBASE, MEDLINE (OVID), Scopus, and Web of Science were searched for relevant articles published until September 30, 2025. A Z-test using a random effects model was used to pool study-level results to obtain pooled standardized mean difference- and its 95% confidence intervals. A P value of <0.05 indicated statistical significance. RESULTS: After screening a total of 331 unique articles, 14 studies, including 2,097 patients (562 restenosis cases/1,535 no-restenosis controls), were available for quantitative synthesis. Pooled results suggested a significant association between higher pre-endovascular intervention CRP levels and femoropopliteal artery restenosis. (standardized mean difference = 0.44, 95% confidence interval, 0.09-0.78, P = 0.01). There was no evidence of publication bias, both visually via Begg's funnel plot and statistically via Egger's test results (P = 0.52). Leave-one-out sensitivity analysis supported the robustness of the pooled results. CONCLUSION: This systematic review and study-level meta-analysis suggests a significant association between higher pre-endovascular intervention CRP levels and the subsequent development of femoropopliteal artery restenosis. Our findings should be interpreted with caution and further large-scale prospective investigations are warranted to substantiate our results.

Source: Annals of Vascular Surgery

DOI: 10.1016/j.avsg.2026.04.031