{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:20:36Z","timestamp":1780446036329,"version":"3.54.1"},"reference-count":28,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T00:00:00Z","timestamp":1759708800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Vascular calcification has been highlighted as a prognostic factor for perioperative thrombosis but a protective factor for late restenosis in lower limb peripheral artery disease (LLPAD). The aim of this study was to investigate the association between calcification and twelve-month primary patency in patients with stenting of the common femoral artery (CFA) and its bifurcation for atheromatous stenosis. Materials\/Methods: This single-center retrospective study analyzed consecutive limbs (n = 90) that underwent CFA stenting for symptomatic lesions between January 2018 and January 2023. Calcification was assessed using dedicated computed tomography angiography analysis software (EndoSize; Therenva), with blinded evaluation of volume (mm3) and density (Hounsfield Units) across three anatomically distinct zones: proximal CFA (Zone 1); distal CFA (Zone 2); and bifurcation segments (Zone 3). The primary endpoint was twelve-month primary patency, defined as a peak systolic velocity ratio (PSVR) &lt; 2.4 on duplex ultrasound without target lesion revascularization. Secondary endpoints included predictors of restenosis using multivariable logistic regression. Results: Ninety cases of CFA stenting for LLPAD (lower limb peripheral artery disease) were analyzed. A total of 78.9% of CFA lesions were treated for claudication and 21.1% for critical limb-threatening ischemia (CLTI). Lesions were distributed as Azema types I (1%), II (43%), and III (56%). At twelve-month follow-up, primary patency (PSVR &lt; 2.4) was achieved in 77.4% of limbs. Patent CFA stenting demonstrated significantly higher median calcification density in Zone 2 compared to those with restenosis (1122 [IQR: 903\u20131248] vs. 858 [788\u2013987] HU; p = 0.006; q = 0.021 after false discovery rate correction). ROC curve analysis identified a density threshold of 800 HU with a 76% reduction in restenosis risk (OR 0.24; 95% CI: 0.08\u20130.72; p = 0.011). Bootstrap validation (1000 replications) confirmed threshold stability at 821 HU (95% CI: 656\u2013990 HU). Conclusions: In this exploratory study, dense calcification (\u2265800 HU) in the distal CFA appears to be protective against twelve-month restenosis following stenting. These findings suggest that calcification density may serve as a valuable predictor for patient selection and procedural planning in CFA interventions.<\/jats:p>","DOI":"10.3390\/jcm14197052","type":"journal-article","created":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T15:05:06Z","timestamp":1759763106000},"page":"7052","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Dense Calcification of the Common Femoral Artery Is Protective Against In-Stent Restenosis"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-1233-1179","authenticated-orcid":false,"given":"Camil-Cassien","family":"Bamd\u00e9","sequence":"first","affiliation":[{"name":"Cardiovascular and Thoracic Surgery Department, Dijon University Hospital, 21000 Dijon, France"},{"name":"Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), EA 7460, Faculty of Health Sciences, University of Burgundy, 21000 Dijon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yann","family":"Goueffic","sequence":"additional","affiliation":[{"name":"Vascular and Endovascular Surgery Department, Paris Saint-Joseph Hospital, 75014 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Michel","family":"Davaine","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Facult\u00e9 de M\u00e9decine, Sorbonne Universit\u00e9, Assistance Publique-H\u00f4pitaux de Paris (APHP), H\u00f4pital Europ\u00e9en Georges Pompidou (HEGP), 20 rue Leblanc, 75015 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alain","family":"Lalande","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, Dijon University Hospital, 21000 Dijon, France"},{"name":"ICMUB Laboratory, University of Burgundy, 21000 Dijon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3554-7714","authenticated-orcid":false,"given":"Charles","family":"Guenancia","sequence":"additional","affiliation":[{"name":"Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), EA 7460, Faculty of Health Sciences, University of Burgundy, 21000 Dijon, France"},{"name":"Cardiology Department, Dijon University Hospital, 21000 Dijon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Steinmetz","sequence":"additional","affiliation":[{"name":"Cardiovascular and Thoracic Surgery Department, Dijon University Hospital, 21000 Dijon, France"},{"name":"Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), EA 7460, Faculty of Health Sciences, University of Burgundy, 21000 Dijon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1177\/1538574417702773","article-title":"Management of Isolated Atherosclerotic Stenosis of the Common Femoral Artery: A Review of the Literature","volume":"51","author":"Halpin","year":"2017","journal-title":"Vasc. 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