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Systemic arterial calcium burden in patients with chronic limb-threatening ischemia
L C D Konijn1, W P T M Mali2, H van Overhagen3
1Haga Hospital, Department of Diagnostic and Interventional Radiology, the Netherlands; University Medical Center Utrecht and Utrecht University, Department of Radiology and Nuclear Medicine, the Netherlands.
Insights
Chronic limb-threatening ischemia (CLTI) patients exhibit widespread arterial calcification across multiple territories. This systemic calcification is strongly linked to poor outcomes and high mortality rates in CLTI patients.
Area of Science:
- Vascular Medicine
- Cardiology
- Radiology
Background:
- Chronic limb-threatening ischemia (CLTI) carries a high 5-year mortality rate (50-60%), primarily due to coronary artery disease (CAD) and stroke.
- Understanding the extent of arterial calcification in CLTI patients is crucial for risk stratification and management.
Purpose of the Study:
- To quantify and qualify the calcium load in various arterial territories of patients diagnosed with CLTI.
- To investigate the correlation between calcification in different arterial beds within CLTI patients.
Main Methods:
- Prospective study including 60 CLTI patients who underwent full-body CT scans.
- Analysis of calcification in peripheral lower extremity arteries, coronary arteries, carotid arteries (extracranial and intracranial), thoracic aorta, and abdominal aorta.
- Quantitative and semi-quantitative CT measurements were analyzed for interrelations.
Main Results:
- Nearly all CLTI patients presented with severe arterial calcifications in femoropopliteal (100%), crural (98.1%), coronary (100%), carotid bifurcation (96.2%), internal carotid artery (98.1%), thoracic aorta (96.2%), and abdominal aorta (92.3%).
- A significant proportion of patients had very high (57%) or extremely high (35%) coronary Agatston scores.
- Lower extremity arterial calcifications strongly correlated with coronary artery calcium (CAC) score and carotid bifurcation calcification, and to a lesser extent with aortic calcifications.
Conclusions:
- CLTI patients demonstrate severe, systemic arterial calcification across nearly all analyzed territories.
- Widespread arterial calcification in CLTI patients likely contributes significantly to the disease's poor prognosis and high mortality.
Introduction:
5-year mortality of chronic limb-threatening ischemia (CLTI) is 50-60% and coronary artery disease (CAD) is the main cause of death of CLTI patients, followed by stroke. The aim of this study is to quantify and qualify the calcium load in different arterial territories in patients with CLTI.
Methods:
Prospectively, 60 patients with CLTI were included and received a full-body CT scan. 6 patients were excluded. Different arterial territories (the peripheral lower extremity arteries, coronary arteries, extracranial and intracranial carotid arteries, thoracic and abdominal aorta) were analyzed. Analysis and interrelations of both quantitative and semi-quantitative CT measurements was performed.
Results:
Mean age was 72 years (range 47-95; SD 11.4). Almost all CLTI patients had calcified arterial beds (femoropopliteal 100%, crural 98.1%, coronary 100%, carotid bifurcation 96.2%, internal carotid artery 98.1%, thoracic aorta 96.2%, abdominal aorta 92.3%). Nearly all arterial territories had severe calcifications. 57% had a very high coronary Agatston score (>1000), and 35% extremely high (>2000). Calcifications in the lower extremity were significantly correlated to CAC score, carotid artery bifurcation calcification score, and to a lesser extent correlated to annular calcifications in the aorta. Very high and extremely high total CAC scores were strongly correlated with severe lower extremity arterial calcifications and severe carotid and intracranial internal carotid artery, thoracic and abdominal aorta calcifications in patients with CLTI patients.
Conclusions:
In CLTI patients nearly all arterial territories are severely calcified, suggesting that systemic calcification plays an important role in the poor outcome of this disease.
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