Vascular Calcification Patterns in the Elderly: Correlation Between Aortic and Iliac Calcification Burden

Background: Vascular calcification is a frequent consequence of ageing and is associated with an increased risk of cardiovascular disease. This study aimed to compare two rapid scoring systems for quantifying calcification of the distal abdominal aorta and iliac arteries and to investigate correlations with increasing age. Methods: Patients aged ≥65 years who sustained pelvic trauma between 2003 and 2023 and underwent computed tomography (CT) were included in this retrospective study. Patients were categorised into three age groups (65-74, 75-84, ≥85). The abdominal aorta calcification score (AACS) and the common, external, and total iliac artery calcification scores (CIACS, EIACS, TIACS) were assessed on cross-sectional images and classified into three severity grades (mild, moderate, severe). Results: A total of 224 patients (mean age 78.8 ± 8.5 years; 62% female) were included. Significant differences between age groups were identified for hypertension (p < 0.001), osteoporosis (p < 0.001), atrial fibrillation (p = 0.015), chronic heart failure (p = 0.004), chronic kidney disease (p < 0.001), neurocognitive disorders (p < 0.001), and anticoagulant therapy (p = 0.002). Calcification severity increased with age across all vascular territories (EIACS p = 0.006; others p < 0.001). In multivariable linear regression, age remained the strongest adjusted predictor of calcification across all vascular regions (β = 0.323-0.376, all p < 0.001). Significant positive correlations were found between aortic and iliac calcifications (all p < 0.001), strongest between AACS and CIACS (ρ = 0.78, CI 0.719-0.835) and TIACS (ρ = 0.745, CI 0.676-0.807). Corresponding categorical associations were most pronounced between AACS and CIACS. Conclusions: The evaluated calcification scores were strongly correlated and demonstrated clear age-dependent trends. Given their simplicity and applicability to routine CT imaging, these methods may provide practical tools for assessing vascular ageing.