INTRODUCTION AND OBJECTIVES Strategies for the most effective treatment for peripheral arterial disease (PAD) remain controversial among clinicians. Several trials have shown improved primary patency of infrainguinal interventions with the utilization of paclitaxel-coated balloons or stents (DCBS) compared to conventional balloons or stents. However, a 2018 meta-analysis suggested an increased mortality risk for patients receiving DCBS, resulting in an international pause in the use of DCBS. A 2021 meta-analysis by the same group suggested an increased risk of major amputation following DCBS use in peripheral arterial revascularization procedures. Here we report our long-term institutional outcomes comparing uncoated devices to DCBS. METHODS We performed a retrospective review of all patients who underwent peripheral arterial angioplasty, stenting, atherectomy, or a combination between 2011 and 2020 within our regional healthcare system. Univariate and survival analyses were performed using standard statistical methods to assess the primary endpoints of overall survival, 5-year survival, and amputation-free survival. RESULTS A total of 2717 patients were identified, of whom 1965 were treated with conventional uncoated devices and 752 were treated with DCBS. Univariate analysis demonstrated longer survival time for patients receiving conventional angioplasty (20.9 months vs. 9.8 months, p<0.0001). However, log-rank test found no significant difference in overall survival probability (p=0.9375), 5-year survival probability (p=0.9876), and amputation-free survival (p=0.3310). Proportional hazards model found that patients using beta blockers or aspirin, or with dyslipidemia, prior coronary artery bypass graft (CABG), or hypercoagulability were at increased risk of mortality following treatment with paclitaxel or conventional devices. CONCLUSIONS DCBS are not associated with increased mortality or worse amputation-free survival in this real-world cohort of patients treated for PAD. Additionally, our data indicates that mortality is linked to pre-existing patient factors rather than type of device utilized. Strategies for the most effective treatment for peripheral arterial disease (PAD) remain controversial among clinicians. Several trials have shown improved primary patency of infrainguinal interventions with the utilization of paclitaxel-coated balloons or stents (DCBS) compared to conventional balloons or stents. However, a 2018 meta-analysis suggested an increased mortality risk for patients receiving DCBS, resulting in an international pause in the use of DCBS. A 2021 meta-analysis by the same group suggested an increased risk of major amputation following DCBS use in peripheral arterial revascularization procedures. Here we report our long-term institutional outcomes comparing uncoated devices to DCBS. We performed a retrospective review of all patients who underwent peripheral arterial angioplasty, stenting, atherectomy, or a combination between 2011 and 2020 within our regional healthcare system. Univariate and survival analyses were performed using standard statistical methods to assess the primary endpoints of overall survival, 5-year survival, and amputation-free survival. A total of 2717 patients were identified, of whom 1965 were treated with conventional uncoated devices and 752 were treated with DCBS. Univariate analysis demonstrated longer survival time for patients receiving conventional angioplasty (20.9 months vs. 9.8 months, p<0.0001). However, log-rank test found no significant difference in overall survival probability (p=0.9375), 5-year survival probability (p=0.9876), and amputation-free survival (p=0.3310). Proportional hazards model found that patients using beta blockers or aspirin, or with dyslipidemia, prior coronary artery bypass graft (CABG), or hypercoagulability were at increased risk of mortality following treatment with paclitaxel or conventional devices. DCBS are not associated with increased mortality or worse amputation-free survival in this real-world cohort of patients treated for PAD. Additionally, our data indicates that mortality is linked to pre-existing patient factors rather than type of device utilized.