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Different Lower Extremity Arterial Calcification Patterns in Patients with Chronic Limb-Threatening Ischemia Compared
Louise C D Konijn1, Richard A P Takx2, Willem P Th M Mali2
1Department of Diagnostic and Interventional Radiology, Haga Teaching Hospital, Els Borst-Eilersplein 275, 2545 AA The Hague, The Netherlands.
Insights
Critical limb-threatening ischemia (CLI) patients exhibit more frequent and extensive arterial calcification than non-peripheral arterial disease (PAD) patients. CLI patients show annular calcifications in crural arteries, unlike dot-like patterns in non-PAD individuals, suggesting different etiologies.
Area of Science:
- Vascular Biology
- Medical Imaging
- Peripheral Arterial Disease Research
Background:
- Peripheral arterial disease (PAD) is a significant vascular condition, with critical limb-threatening ischemia (CLI) representing its most severe form.
- Arterial calcification is a key factor in CLI, influencing symptoms, amputation rates, and mortality.
- However, arterial calcification also occurs in asymptomatic individuals without PAD, necessitating a deeper understanding of calcification patterns.
Purpose of the Study:
- To investigate and compare the patterns of arterial calcification in patients with CLI versus asymptomatic non-PAD individuals.
- To determine if distinct calcification characteristics can explain the symptomatic presentation in CLI patients.
Main Methods:
- Computed tomography (CT) of the lower extremities was performed on 130 CLI patients and 204 non-PAD patients.
- 118 CLI patients were age-matched with 118 non-PAD patients for comparative analysis.
- Calcification characteristics (severity, annularity, thickness, continuity) in femoral and crural arteries were assessed and analyzed using logistic regression.
Main Results:
- CLI patients displayed significantly more frequent and extensive arterial calcification (98.3% femoropopliteal, 97.5% crural) compared to non-PAD patients (67% overall).
- Crural arteries in CLI patients showed more complete annular calcifications (OR 2.92), while non-PAD patients predominantly had dot-like calcifications.
- Femoropopliteal arteries in CLI patients had more severe, irregular/patchy, and thicker calcifications, contrasting with thin continuous calcifications in non-PAD patients.
Conclusions:
- Arteries in the lower extremities of CLI patients are more frequently and extensively calcified than in non-PAD patients.
- Distinct calcification patterns, such as annular in crural arteries for CLI patients and dot-like for non-PAD patients, were observed.
- These differing calcification patterns suggest varied etiologies for CLI and non-PAD, potentially impacting prognosis and treatment strategies.
Objectives:
The most severe type of peripheral arterial disease (PAD) is critical limb-threatening ischemia (CLI). In CLI, calcification of the vessel wall plays an important role in symptoms, amputation rate, and mortality. However, calcified arteries are also found in asymptomatic persons (non-PAD patients). We investigated whether the calcification pattern in CLI patients and non- PAD patients are different and could possibly explain the symptoms in CLI patients.
Materials And Methods:
130 CLI and 204 non-PAD patients underwent a CT of the lower extremities. This resulted in 118 CLI patients (mean age 72 ± 12, 70.3% male) that were age-matched with 118 non-PAD patients (mean age 71 ± 11, 51.7% male). The characteristics severity, annularity, thickness, and continuity were assessed in the femoral and crural arteries and analyzed by binary multiple logistic regression.
Results:
Nearly all CLI patients have calcifications and these are equally frequent in the femoropopliteal (98.3%) and crural arteries (97.5%), while the non-PAD patients had in just 67% any calcifications with more calcifications in the femoropopliteal (70.3%) than in the crural arteries (55.9%, p < 0.005). The crural arteries of CLI patients had significantly more complete annular calcifications (OR 2.92, p = 0.001), while in non-PAD patients dot-like calcifications dominated. In CLI patients, the femoropopliteal arteries had more severe, irregular/patchy, and thick calcifications (OR 2.40, 3.27, 1.81, p ≤ 0.05, respectively) while in non-PAD patients, thin continuous calcifications prevailed.
Conclusions:
Compared with non-PAD patients, arteries of the lower extremities of CLI patients are more frequently and extensively calcified. Annular calcifications were found in the crural arteries of CLI patients while dot-like calcifications were mostly present in non-PAD patients. These different patterns of calcifications in CLI point at different etiology and can have prognostic and eventually therapeutic consequences.
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