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Association of arterial calcification with chronic limb ischemia in patients with peripheral artery disease
Sara L Zettervall1, Andre P Marshall2, Paul Fleser3
1Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass; Division of Vascular Surgery, George Washington University Medical Center, Washington, D.C.
Insights
Peripheral artery calcification (PAC) is independently linked to more severe limb ischemia in peripheral artery disease patients. This finding highlights the importance of assessing calcification in managing limb health and preventing amputation.
Area of Science:
- Vascular Medicine
- Radiology
- Cardiovascular Disease
Background:
- Arterial calcification is a known risk factor for limb events, including amputation.
- The correlation between lower extremity artery calcification and the severity of limb ischemia has not been thoroughly investigated.
- Peripheral artery disease (PAD) management requires understanding factors contributing to limb status deterioration.
Purpose of the Study:
- To determine if the extent of peripheral artery calcification (PAC) correlates with Rutherford chronic ischemia categories in PAD patients.
- To test the hypothesis that PAC independently contributes to worsening limb status.
- To identify factors associated with increasing Rutherford ischemia categories in symptomatic PAD.
Main Methods:
- Retrospective review of 116 patients with symptomatic PAD evaluated via computed tomography (CT) scans of the lower extremities.
- Assessment of demographic, cardiovascular risk factors, Rutherford ischemia categories, peripheral artery calcification (PAC) scores, and extent of occlusive disease.
- Statistical analysis using Spearman's correlation and multivariable logistic regression to identify associations.
Main Results:
- Univariate analysis showed significant associations between increasing Rutherford ischemia category and age, diabetes duration, hypertension, occlusion score, and PAC.
- A moderate correlation (Spearman's R = 0.6) was observed between occlusive disease extent and PAC scores.
- Multivariable analysis revealed that tobacco use (OR, 3.1), diabetes duration (OR, 1.04), and PAC score (OR, 2.1) were independently associated with increased ischemia categories.
Conclusions:
- Peripheral artery calcification (PAC) is an independent predictor of increased ischemia severity in patients with peripheral artery disease.
- The findings suggest that PAC plays a significant role in the progression of limb ischemia.
- Further research is warranted to elucidate the mechanisms linking arterial calcification to worsening limb ischemia.
Objective:
Arterial calcification is associated with an increased risk of limb events, including amputation. The association between calcification in lower extremity arteries and the severity of ischemia, however, has not been assessed. We thus sought to determine whether the extent of peripheral artery calcification (PAC) was correlated with Rutherford chronic ischemia categories and hypothesized that it could independently contribute to worsening limb status.
Methods:
We retrospectively reviewed all patients presenting with symptomatic peripheral artery disease who underwent evaluation by contrast and noncontrast computed tomography scan of the lower extremities as part of their assessment. Demographic and cardiovascular risk factors were recorded. Rutherford ischemia categories were determined based on history, physical examination, and noninvasive testing. PAC scores and the extent of occlusive disease were measured on noncontrast and contrast computed tomography scans, respectively. Spearman's correlation testing was used to assess the relationship between occlusive disease and calcification scores. Multivariable logistic regression was used to identify factors associated with increasing Rutherford ischemia categories.
Results:
There were 116 patients identified, including 75 with claudication and 41 with critical limb ischemia. In univariate regression, there was a significant association between increasing Rutherford ischemia category and age, diabetes duration, hypertension, the occlusion score, and PAC. There was a moderate correlation between the extent of occlusive disease and PAC scores (Spearman's R = 0.6). In multivariable analysis, only tobacco use (odds ratio [OR], 3.1; 95% confidence interval [CI], 1.2-8.3), diabetes duration (OR, 1.04; 95% CI, 1.01-1.08), and the calcification score (OR, 2.1; 95% CI, 1.4-3.2) maintained an association with increasing ischemia categories after adjusting for relevant cardiovascular risk factors and the extent of occlusive disease.
Conclusions:
PAC is independently associated with increased ischemia categories in patients with peripheral artery disease. Further research aimed at understanding the relationship between arterial calcification and worsening limb ischemia is warranted.
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