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Pedal arterial calcification score is associated with hemodynamic change and major amputation after infrainguinal

Iris H Liu1, Bian Wu1, Viktoriya Krepkiy1

  • 1Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Francisco, CA.

Journal of Vascular Surgery
|July 19, 2022
PubMed

Insights

Pedal medial arterial calcification (pMAC) predicts persistent ischemia and amputation risk in chronic limb-threatening ischemia (CLTI) patients after revascularization. Higher pMAC scores indicate a greater likelihood of poor outcomes, especially after endovascular treatment.

Area of Science:

  • Vascular Surgery
  • Radiology
  • Cardiovascular Medicine

Background:

  • Pedal medial arterial calcification (pMAC) is linked to major amputation in chronic limb-threatening ischemia (CLTI).
  • The association between pMAC and amputation may stem from unresolved distal ischemia.
  • This study investigates the relationship between pMAC, hemodynamic changes, and amputation risk post-revascularization for CLTI.

Purpose of the Study:

  • To investigate the relationships between pedal medial arterial calcification (pMAC) score, hemodynamic changes, and major amputation.
  • To determine if pMAC is associated with persistent distal ischemia after infrainguinal revascularization for CLTI.
  • To evaluate the influence of pMAC on outcomes following different revascularization techniques (endovascular vs. open bypass).

Main Methods:

  • Retrospective study of 306 CLTI patients undergoing infrainguinal revascularization (2011-2020).
  • Blinded pMAC scoring (0-5) from foot X-rays; toe pressures measured pre- and post-procedure in 136 patients.
  • Ischemia severity assessed using the Society for Vascular Surgery Wound, Ischemia, foot Infection (WIfI) system.

Main Results:

  • Lower pMAC scores correlated with improved hemodynamics (P = .004).
  • Failure to improve WIfI ischemia grade was associated with major amputation (P = .0002).
  • After endovascular treatment, pMAC 5 independently predicted unimproved ischemia (OR: 4.0) and was associated with major amputation (HR: 15.5).
  • After bypass, nonautologous conduit use was the sole predictor of major amputation (HR: 5.6).

Conclusions:

  • pMAC score is independently associated with persistent distal ischemia and major amputation after CLTI revascularization.
  • pMAC may serve as a marker for hemodynamic response and limb loss risk, particularly after endovascular interventions.
  • These findings highlight the prognostic value of pMAC in CLTI management.
Abstract

Keywords:
AmputationChronic limb-threatening ischemiaMonckeberg medial calcific sclerosisPeripheral arterial diseaseVascular calcification

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