Devia-Rodriguez Raul, Derksen Maikel, El Moumni Mostafa, de Groot Kristian, Vedder Issi R, Zeebregts Clark J, Bokkers Reinoud P H, Pol Robert A, de Vries Jean-Paul P M, Schuurmann Richte C L
Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Ann Vasc Surg. 2025 Feb;111:290-298. doi: 10.1016/j.avsg.2024.11.009. Epub 2024 Nov 22.
The accumulation of calcium load in peripheral lower extremity arteries has been associated with increased severity of peripheral artery disease (PAD) and mortality. While calcium scores are commonly calculated from non-contrast computed tomography (CT) scans, patients with PAD often undergo contrast-enhanced CT scans. This study aims to explore the association between a length-adjusted calcium score (LACS) of the iliofemoral arteries, determined through pre-intervention contrast-enhanced CT, and major adverse events in patients with chronic limb-threatening ischemia (CLTI).
A cohort of CLTI patients subjected to endovascular revascularization between 2005 and 2017 at a tertiary referral center were categorized into 2 groups. The complication group experienced one of the composite outcomes (reintervention, above-the-ankle amputation, and/or all-cause mortality within 1 year of the primary endovascular procedure), while control patients did not encounter this composite endpoint. Patients from the complication group were matched one-to-one with controls based on sex and Fontaine classification. LACS was calculated (Ca volume[mm]/length[cm]) at 3 arterial segments; 1. the common iliac artery (CIA), 2. the external iliac artery and common femoral artery (EIA + CFA), and 3. the superficial femoral artery plus the popliteal artery (SFA + PA). Binary logistic regression analysis was conducted to investigate the association between LACS in the different arterial segments and the occurrence of the composite binary outcome (complication and control) and LACS of the different segments, adjusting influences of age, sex, BMI >25, Fontaine classification, diabetes mellitus type 1 & 2, chronic kidney disease stage, and hemodialysis treatment.
Sixty-four CLTI patients were included in this study (complication group [n = 32], and control group [n = 32]). A significant difference (higher LACS was found for the complication group in the CIA, the SFA + PA, as well as the total trajectory. CLTI patients with high LACS in the SFA + PA or the total trajectory were more likely to suffer adverse events (SFA + PA: OR: 1.010, 95% CI: 1.000-1.020, P = 0.04; Total LACS: OR: 1.008, 95% CI: 1.000-1.017, P = 0.05).
Patients with a high calcium load in the ilio-femoral arteries are at increased risk of major adverse events during 1 year after endovascular revascularization. The calcium score, derived from contrast-enhanced CT scans, holds potential utility in decision making for CLTI patients.
外周下肢动脉中钙负荷的积累与外周动脉疾病（PAD）的严重程度增加及死亡率相关。虽然钙分数通常通过非增强计算机断层扫描（CT）计算得出，但PAD患者常接受增强CT扫描。本研究旨在探讨通过干预前增强CT确定的髂股动脉长度调整钙分数（LACS）与慢性肢体威胁性缺血（CLTI）患者主要不良事件之间的关联。
2005年至2017年在一家三级转诊中心接受血管内血运重建的CLTI患者队列被分为两组。并发症组经历了复合结局之一（再次干预、踝关节以上截肢和/或在初次血管内手术后1年内的全因死亡率），而对照组患者未遇到该复合终点。根据性别和Fontaine分类，将并发症组患者与对照组患者进行一对一匹配。在3个动脉节段计算LACS（钙体积[mm]/长度[cm]）；1. 髂总动脉（CIA），2. 髂外动脉和股总动脉（EIA + CFA），3. 股浅动脉加腘动脉（SFA + PA）。进行二元逻辑回归分析，以研究不同动脉节段的LACS与复合二元结局（并发症和对照）的发生之间的关联以及不同节段的LACS，调整年龄、性别、BMI>２５、Fontaine分类、1型和2型糖尿病、慢性肾病分期及血液透析治疗的影响。
本研究纳入了64例CLTI患者（并发症组[n = 32]，对照组[n = 32]）。在CIA、SFA + PA以及总路径中，并发症组的LACS存在显著差异（更高）。SFA + PA或总路径中LACS高的CLTI患者更易发生不良事件（SFA + PA：OR：1.010，95%CI：1.000 - 1.020，P = 0.04；总LACS：OR：1.008，95%CI：1.000 - 1.017，P = 0.05）。
髂股动脉钙负荷高的患者在血管内血运重建后1年内发生主要不良事件的风险增加。源自增强CT扫描的钙分数在CLTI患者的决策制定中具有潜在效用。
