Department of Vascular Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Medical Student, Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, Brazil.
J Endovasc Ther. 2022 Jun;29(3):438-443. doi: 10.1177/15266028211059911. Epub 2021 Nov 26.
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.
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.
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).
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.
钙评分是血管壁钙化的一种测量方法，在不同的血管床中进行研究时有临床应用。下肢动脉的血管钙化在患有外周动脉疾病的患者中非常常见；然而，其与下肢血运重建术后结局的关系仍研究甚少。本研究旨在评估下肢钙评分与接受下肢血运重建术的外周动脉疾病患者术后结局之间的关系。
我们回顾性分析了 72 例因严重肢体缺血而行增强 CT 术前评估的患者的 88 例下肢血运重建术。从术前 CT 的血管造影期计算主动脉、髂动脉、股腘动脉和腘下动脉节段的钙评分。还计算了手术肢体和使用标准化方法的总钙评分。评估的结局包括急性心肌梗死、截肢、通畅性、技术成功和任何原因导致的死亡。患者通过 12 个月的随访。
在进行的 88 例手术中，31 例（43.1%）病变被归类为跨大西洋国际共识文档 II D。其中 66 例（75%）为血管内治疗，16 例（18.2%）为开放手术，6 例（6.8%）为杂交介入。在任何分析的时间段内，节段钙评分（主动脉、髂动脉、股腘动脉、腘下动脉、手术肢体和总钙评分）与急性心肌梗死、截肢、通畅性和技术成功的结局之间均未发现统计学显著相关性。术后 30 天和 6 个月内死亡的患者手术肢体的钙评分较高（6571 比 2590.6；p=0.026）和（5227.8 比 2335.3；p=0.036）。
使用 CT 血管造影期计算标准化钙评分是可行且可重复的。手术肢体钙化程度较高与术后死亡的几率增加相关。手术肢体的钙评分可作为该组患者临床严重程度和预后的标志物。
