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Medial arterial calcification score is associated with increased risk of major limb amputation

Alexander D DiBartolomeo1, Sydney E Browder2, Sebouh Bazikian1

  • 1Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA.

Journal of Vascular Surgery
|August 1, 2023
PubMed

Insights

The pedal medial arterial calcification (MAC) score helps predict major limb amputation risk in patients with chronic limb-threatening ischemia. A higher MAC score indicates a greater risk, aiding in treatment decisions.

Area of Science:

  • Vascular Surgery
  • Radiology
  • Podiatry

Background:

  • Chronic limb-threatening ischemia (CLTI) poses a significant risk of major limb amputation.
  • Medial arterial calcification (MAC) is a known predictor of adverse outcomes in CLTI.
  • The pedal MAC score specifically assesses calcification in inframalleolar arteries.

Purpose of the Study:

  • To validate the pedal medial arterial calcification (MAC) scoring system.
  • To assess the utility of the pedal MAC score in predicting major limb amputation risk.
  • To confirm the reproducibility and generalizability of the pedal MAC score in a multi-institutional setting.

Main Methods:

  • Retrospective, multi-institutional study of 176 patients undergoing infrainguinal revascularization for CLTI.
  • Pedal MAC scores (0-5) assigned from foot X-rays, then trichotomized (0-1, 2-4, 5).
  • Primary outcome: major limb amputation at 6 months, analyzed using Adjusted Kaplan-Meier models.

Main Results:

  • A total of 184 limbs were analyzed; 14% (26 limbs) underwent major amputation within 6 months.
  • Patients with a pedal MAC score of 5 demonstrated a significantly higher risk of major limb amputation compared to those with scores of 0-1 and 2-4.
  • Overall amputation-free survival was lower in patients with higher MAC scores (log-rank P = .008).

Conclusions:

  • The pedal MAC score is a reproducible and generalizable measure of inframalleolar arterial disease.
  • The pedal MAC score can be integrated with Wound, Ischemia, and foot Infection (WIfI) staging.
  • This combined approach aids in predicting major limb amputation risk in patients with CLTI.
Abstract

Keywords:
AmputationChronic limb-threatening ischemiaLower extremity revascularizationMedial arterial calcification

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