There was no difference in limb salvage rates, but patency and amputation-free survival rates were better 1 year after bypass surgery.

The burden of calcified plaque, but not soft or fibrocalcific plaque is related to restenosis, reintervention, and AFS. Computed tomography plaque analysis may form an important non-invasive tool for risk stratification in patients undergoing F-P endovascular procedures.

Background The incidence of, and risk factors for, acute kidney injury (AKI) after endovascular intervention for peripheral artery disease (PAD) remain unknown. The aim of this study was to assess the proportion of patients who develop AKI and explore the risk factors. Methods Prospectively collected data on patients undergoing femoropopliteal endovascular intervention for symptomatic PAD across three vascular centres were analysed. The proportion of patients developing AKI (according to the Kidney Disease Improving Global Outcomes definition) within 48 h, and the proportion developing the composite Major Adverse Kidney Events (MAKE) endpoints (death, dialysis, drop in estimated glomerular filtration rate at least 25 per cent) at 30 days (MAKE30) and remains 90 days (MAKE90) were calculated. Multivariable regression analysis was used to assess predictors of AKI, and the association between AKI and death. Results Some 2041 patients were included in the analysis. AKI developed in 239 patients (11.7 per cent), with 47 (2.3 per cent) requiring dialysis within 30 days, and 18 (0.9 per cent) requiring ongoing dialysis. The MAKE30 and MAKE90 composite endpoints were reached in 358 (17.5 per cent) and 449 (22.0 per cent) patients respectively. Risk factors for AKI were age, sex, congestive heart failure, chronic limb-threatening ischaemia, emergency procedure, and pre-existing chronic kidney disease. AKI, dementia, congestive heart failure, and major amputation were risk factors for medium-term mortality. Conclusion AKI is a common complication after intervention for PAD and is associated with medium-term mortality.

WHAT THIS PAPER ADDS Percutaneous transluminal angioplasty (PTA) is a common treatment for femoro-popliteal segment (F-P) atherosclerotic disease. The use of biomimetic nitinol stents (Supera peripheral stent, SPS) or drug eluting stents (DES) may improve F-P PTA patency. These devices, however, have not been compared in a pragmatic setting taking plaque characteristics into account. This case matched analysis shows that SPS and DES have comparable results in F-P PTA. Using a DES did not confer a measurable benefit in terms of patency or clinical results at two years. At the same time, the SPS also did not confer a benefit in the heavily calcified plaques. Background: Percutaneous transluminal angioplasty (PTA) is a common procedure in patients with peripheral arterial disease (PAD) affecting the femoropopliteal segment (F-P). Biomimetic nitinol stents (Supera peripheral stent, SPS) and drug eluting stents (DES) were designed to improve the longevity of F-P PTA; however, their performance has not been compared in a pragmatic setting, taking atherosclerotic plaque characteristics into account. Methods: Overall, 296 consecutive patients (mean age: 73 y, SD: 11 y, 65% male, 68% with chronic limb threatening ischaemia) who underwent F-P PTA using SPS or DES between 2013 and 2018 were identified from a prospectively maintained institutional database. Patient and plaque characteristics, including F-P plaque characterisation based on computed tomography, were collected; 121 case matched pairs were created using a propensity score based on patient and plaque data. Results: During the median two year follow up, 28% of the cohort (32% SPS vs. 24% DES, p ¼ .07) developed target lesion restenosis (TLR) > 50%. Among the 121 case matched pairs of patients, those with SPS vs. DES were not significantly more likely to develop TLR >50% (31% vs. 27%, p ¼ .34), or stent occlusion (13% vs. 12%, p ¼ .85 e secondary patency rate 87% vs. 88%), have a major amputation (10% vs. 6%, p ¼ .16), require re-intervention (14% vs. 9%, p ¼ .12), or die (7% vs.4%, p ¼ .31). Plaque calcification did not predict restenosis or occlusion in either stent group, both in the matched and non matched populations. Multivariable analysis adjusted for patient and plaque characteristics revealed that the main predictors of restenosis >50% at two years were female sex [odds ratio (OR): 2.05, p ¼ .01], hypertension (OR: 2.10, p ¼ .04) and previous F-P occlusion (OR: 1.35, p ¼ .04). Conclusion: Medium term results following F-P PTA with either SPS or DES are comparable, regardless of plaque calcification and patient characteristics.