Background and Aims Drug-coated balloon (DCB) as a new interventional therapeutic technique has been increasingly used. However, it is currently mainly used in the field of coronary artery disease therapy, while studies on its application in peripheral vascular diseases are relatively limited, and especially rare in popliteal artery that spans the joint. Therefore, this study was performed to compare the short-term efficacy and long-term outcomes of using DCB versus common balloon (CB) in the treatment of popliteal arteriosclerosis obliterans, and investigate the application value of DCB in this field.Methods The clinical data of 65 patients with popliteal arteriosclerosis obliterans undergoing interventional balloon dilatation in the Department of Vascular Surgery of the First Hospital of Hebei Medical University from March 2014 to April 2020 were retrospectively analyzed. Of the patients, 29 cases were treated with DCB (DCB group) and 36 cases were treated with CB (CB group). The two groups of patients were matched with propensity score matching (PSM) method at a 1∶1 ratio. After match, the postoperative patency rate of the popliteal artery, ankle-brachial index (ABI) and Rutherford classification as well as the occurrence of endpoint events such as amputation, thrombosis formation and intravascular restenosis were compared between the two groups of patients.Results Twenty-one pairs of patients in the two groups were successfully matched. The clinical data were balanced and comparable between the two groups after match (all P>0.05). After match, the popliteal artery patency rate and ABI at 3 and 6 months after surgery showed no significant difference between the two groups (all P>0.05). At 12 months after surgery, the popliteal artery patency rate and ABI were significantly higher in DCB group than those in CB group (65.71% vs. 49.55%; 0.71% vs. 0.55%, both P<0.05), and the Rutherford classification in DCB group was significantly superior to that in CB group (P<0.05). At one year after surgery, the overall incidence of endpoint events that included amputation, thrombosis formation and intravascular restenosis in DCB group was significantly lower than that in CB group (23.81% vs. 57.14%, P<0.05). The Log-rank test showed that there was a significant difference in the incidence of endpoint events between the two groups of patients (χ2=5.654, P<0.05).Conclusion DCB offers a similar CB short-term efficacy as CB in the treatment of popliteal arteriosclerosis obliterans, but DCB can significantly improve the popliteal artery patency rate and reduce the occurrence of endpoint events in long-term postoperative period.