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Published on: September 22, 2023
Calcium Score Predicts Mortality After Revascularization in Critical Limb Ischemia
Adalberto Megale1, Nelson Wolosker1, Vitória Kalil2
1Department of Vascular Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Insights
The calcium score of the operated limb may indicate prognosis in peripheral arterial disease patients undergoing revascularization. Higher limb calcium scores were linked to increased mortality risk within 30 days and six months post-procedure.
Area of Science:
- Vascular Surgery
- Radiology
- Cardiovascular Disease
Background:
- Vascular calcification is common in peripheral arterial disease (PAD).
- The prognostic value of lower limb vascular calcification after revascularization is not well-established.
- This study investigates the association between calcium score and postoperative outcomes in PAD patients undergoing lower limb revascularization.
Purpose of the Study:
- To evaluate the association between the calcium score of lower limbs and postoperative outcomes.
- To assess the relationship between vascular calcification and critical limb ischemia treatment success.
Main Methods:
- Retrospective analysis of 88 lower limb revascularization procedures in 72 patients with critical limb ischemia.
- Calcium score calculated from preoperative CT angiography (aorta, iliac, femoropopliteal, infrapopliteal, and operated limb).
- Evaluated outcomes included myocardial infarction, amputation, patency, technical success, and death over 12 months.
Main Results:
- No significant association found between segment/total calcium scores and myocardial infarction, amputation, patency, or technical success.
- Higher operated limb calcium scores were significantly associated with increased mortality at 30 days (6571 vs 2590.6; p=0.026) and 6 months (5227.8 vs 2335.3; p=0.036).
Conclusions:
- Standardized calcium score calculation from CT angiography is feasible and reproducible.
- Operated limb calcification severity is linked to a higher risk of postoperative death.
- Operated limb calcium score may serve as a marker of clinical severity and prognosis in PAD patients.
Purpose:
The calcium score is a measure of vessel wall calcification and has clinical applications when studied in different vascular beds. The presence of vascular calcification in the arteries of the lower limbs is very common in patients with peripheral arterial disease; however, its relationship with the postoperative outcomes in patients undergoing lower limb revascularization is still poorly studied. The aim of this study is to evaluate association between the calcium score of lower limbs and the postoperative outcomes in patients with peripheral arterial disease undergoing revascularization procedures.
Methodology:
We retrospectively analyzed 88 lower limb revascularization procedures in 72 patients with critical limb ischemia who had enhanced computed tomography for preoperative evaluation. The calcium score was calculated, from the angiographic phase of preoperative computed tomography, in the segments of the aorta, iliac, femoropopliteal, and infrapopliteal. It was also calculated the calcium score of the operated limb, and the total calcium score using a standardized method. The outcomes evaluated were the occurrence of acute myocardial infarction, amputation, patency, technical success, and death from any cause. Patients were followed up through a 12 month period.
Results:
Among the 88 procedures performed, 31 (43.1%) lesions were classified as Trans-Atlantic Inter-Society Consensus Document II D. There were 66 (75%) endovascular procedures, 16 (18.2%) open surgery, and 6 (6.8%) hybrid interventions. No statistically significant relationship was found between the calcium score of the segments (aorta, iliac, femoropopliteal, infrapopliteal, the operated limb, and total calcium score) and the outcomes of acute myocardial infarction, amputation, patency, and technical success in any of the periods analyzed. The calcium score of the operated limb was higher in patients who died within 30 days and 6 months (6571 vs 2590.6; p=0.026) and (5227.8 vs 2335.3; p=0.036).
Conclusion:
A standardized calcium score calculation method with the angiographic phase of the computed tomography is feasible and reproducible. Higher values of the calcifications of the operated limb are related to a greater chance of death in the postoperative period. The calcium score of the operated limb can be considered as a marker of clinical severity and prognosis in this group of patients.
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