This study states that the Covered stents (CSs) to treat superficial femoral artery (SFA) occlusive disease have become more common. However, concerns about patients’ presenting with acute limb ischemia (ALI) after failure because of coverage of important collaterals have been raised. Herein, we determine whether CSs are associated with ALI after failure. Vascular Quality Initiative peripheral vascular intervention (PVI) and infrainguinal bypass datasets were queried from 2010 to 2020 for patients who underwent SFA stenting with either a bare-metal stent (BMS) or CS (index procedure) and who also had a subsequent ipsilateral SFA endovascular reintervention or bypass recorded in the VQI. Patients with aneurysmal pathology, prior infrainguinal bypass, and ALI at index procedure were excluded. The primary outcome was ALI at reintervention. Other outcomes included higher degree of ischemia (claudication vs rest pain vs tissue loss vs ALI) and reoperative factors. Predictors of the primary outcome were determined with multivariable logistic regression. Index treatment length and pre-index ankle-brachial index were forced into the model. There were 3721 patients: 3338 with index BMS, 383 with index CS. Mean age was 66.6 ± 10.6; 59.3% were male. Baseline covariates were similar between the groups; at index procedure, more BMS patients underwent plain balloon angioplasty.

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