Tibial Artery Calcification Research Articles

Circumferential degree of tibial artery calcification is associated with infrapopliteal endovascular revascularization outcomes in patients with chronic limb-threatening ischemia.

Tibial artery calcification (TAC) is correlated with an increased risk of amputation and mortality in patients with chronic limb-threatening ischemia (CLTI). The association between calcification characteristics and adverse limb events of CLTI. However, it has not been assessed. This study aims to assess the relationship between the characteristics of TAC based on computed tomography angiography (CTA) scans and postoperative outcomes in patients with CLTI undergoing infrapopliteal endovascular therapy. This was a retrospective study of patients who underwent infrapopliteal endovascular revascularization for CLTI and had a preoperative CTA scan. Based on CTA, TAC was divided into the following categories: annularity, thickness, continuity and severity. Cox regression models using generalized estimating equations were performed to assess the relationship between calcification characteristics and postoperative outcomes. The outcomes evaluated were the occurrence of all cause mortality (ACM) and unplanned amputation. Among the 148 patients undergoing endovascular, there were 50 (33.8%) patients died and 26 (17.6%) patients underwent unplanned amputation. Annular calcification was more common in the ACM group than in the non-ACM group. No significant differences were found between the two groups with regard to the probability of calcification in the thickness and the continuity (P>0.05). Patients in the unplanned amputation group had significantly annular, thin and continuity calcifications (P<0.05) than those in the non-unplanned amputation group. The presence of annular calcification was an independent predictor of ACM (hazard ratio (HR), 3.186; 95% confidence interval (CI), 1.781-5.702; P<0.001) and unplanned amputation (HR, 3.739; 95% CI, 1.707-8.191; P<0.05). Among patients with CLTI, the occurrence of annular calcification in the tibial artery are related to a greater chance of ACM and unplanned amputation in the postoperative period. The circumferential degree of TAC of the operated limb can be considered as a marker of clinical prognosis in this group of patients.

Correlation Between Tibial and Coronary Artery Calcification and Their Predictive Value in Major Adverse Limb Events (MALE) and Major Adverse Cardiac Events (MACE)

Correlation Between Tibial and Coronary Artery Calcification and Their Predictive Value in Major Adverse Limb Events (MALE) and Major Adverse Cardiac Events (MACE)

Ultrasound-detected tibial artery calcification as a marker of cardiovascular and lower-limb risk in asymptomatic patients with type-2 diabetes.

Medial arterial calcification (MAC) is a vascular disease distinct from atherosclerosis. Recently, several studies have demonstrated that MAC is an important marker of cardiovascular events. We aim to assess the presence of MAC during ultrasound screening of lower-limb vasculature and its association with both cardiovascular (CV) and lower-limb events in patients with type-2 diabetes. A retrospective cohort study was conducted on 1119 patients with type-2 diabetes free from CV disease. A CV work-up, including vascular ultrasound, was performed for each patient. The presence of MAC was assessed on posterior tibial arteries and ankle-brachial index (ABI) was measured. Major acute CV events (MACEs) and lower-limb events (MALEs) were recorded as a composite endpoint for a 5-year period. We identified MAC among 212 (18.9%) patients. The independent determinants of MAC were age and diabetic retinopathy. Over a period of 5 years, 125 MACEs and 22 MALEs occurred. MAC was significantly associated with the composite outcome MACE + MALE (HR = 1.94; 95% CI: 1.23, 3.08, p = 0.005) or with MACE (HR = 1.85; 95% CI: 1.16, 2.95, p = 0.010). Adjusted for ABI and diabetic foot wound, MAC remained a determinant of MALE (HR = 5.49; 95% CI: 2.19, 13.76, p < 0.001). Considering each ABI group, MAC was associated with both MACE and MALE in the normal ABI group. Ultrasound-detected MAC on tibial arteries seems to be a determinant of both CV and lower-limb events, independent from ABI. MAC helps to refine the CV risk in patients with normal ABI.

Human Cadaveric Model for Vessel Preparation Device Testing in Calcified Tibial Arteries

To describe an ex vivo model for vessel preparation device testing in tibial arteries. We performed orbital atherectomy (OA), intravascular lithotripsy (IVL), and plain balloon angioplasty (POBA) on human amputated limbs with evidence of concentric tibial artery calcification. The arterial segments were then harvested for ex vivo processing which included imaging with microCT, decalcification, and histology. The model was tested out in 15 limbs and was successful in 14 but had to be aborted in 1/15 case due to inability to achieve wire access. A total of 22 lesions were treated with OA on 3/22 lesions, IVL on 8/22, and POBA without vessel preparation on the remaining 11/22. Luminal gain was assessed with intravascular ultrasound and histology was able to demonstrate plaque disruption, dissections, and cracks within the calcified lesions. A human cadaveric model using amputated limbs is a feasible, high-fidelity option for evaluating the performance of vessel preparation devices in calcified tibial arteries.

Effect of high-dose vitamin D supplementation on peripheral arterial calcification: secondary analysis of a randomized controlled trial.

To determine whether vitamin D supplementation has a dose-dependent effect on development and progression of arterial calcification. This was a secondary analysis of the Calgary Vitamin D Study, a 3-year, double-blind, randomized controlled trial conducted at a single-center in Calgary, Canada. Participants were community-dwelling adults aged 55-70years with serum 25-hydroxyvitamin D 30-125nmol/L. Participants were randomized 1:1:1 to receive vitamin D3 400, 4000, or 10,000IU/day for 3years. Tibial artery calcification was identified and quantified (in milligrams of hydroxyapatite, mgHA) using high-resolution peripheral quantitative computed tomography (HR-pQCT) at baseline and 6, 12, 24, and 36months. Changes in calcification over time and treatment group interaction were evaluated using a constrained linear mixed effects model. Of 311 randomized participants, 302 (400: 105, 4000: 96, 10,000: 101) were eligible for analysis of arterial calcification (54% male, mean (SD) age 62 (4) years, mean (SD) 25-hydroxyvitamin D 78.9 (19.9) nmol/L). At baseline, 85 (28%) had tibial artery calcification, and mean (95% CI) calcification quantity was 2.8mgHA (95% CI 1.7-3.9). In these 85 participants, calcification quantity increased linearly by 0.020mgHA/month (95% CI 0.012-0.029) throughout the study, with no evidence of a treatment-group effect (p = 0.645 for interaction). No participants developed new arterial calcifications during the study. In this population of community-dwelling adults who were vitamin D replete at baseline, supplementation with vitamin D 400, 4000, or 10,000IU/day did not have differential effects on the development or progression of arterial calcification over 3years. clinicaltrials.gov (NCT01900860).

The Impact of Femoropopliteal Artery Calcium Score after Endovascular Treatment

The coronary artery calcium score is a widely known independent predictor of cardiac events. Tibial artery calcification had been reported as an amputation risk, but the femoropopliteal artery calcium score is rarely known. A retrospective analysis was performed using the data collected from the patients who underwent endovascular treatment for the femoropopliteal artery between January 2010 and December 2017. The femoropopliteal artery calcium scores on preprocedural computed tomography were calculated according to the Agatston definition. The mean value of total of femoropopliteal artery calcium scores was used to divide the scores into two groups. The prognostic value of the calcium score was analyzed based on primary patency, clinically driven target lesion revascularization, major amputation, and all-cause death. In total, 132 consecutive limbs that underwent successful endovascular intervention were analyzed in this study; 44 and 88 limbs were assigned to the high and low calcium score groups, respectively. There were no significant differences between the two groups in terms of patient and lesion characteristics, except for chronic kidney disease (7% vs. 25%, P<0.01), hemodialysis (80% vs. 25%, P<0.01), and coronary artery disease (73% vs. 53%, P=0.03). Compared with the low calcium score group, the high calcium score group had a significantly higher rate of loss of primary patency and clinically driven target lesion revascularization at one year, based on the Kaplan-Meier curve (55% vs. 81%, 44% vs. 8%, both P<0.01). There were no significant differences between the two groups in terms of major amputation and death. Multivariate analysis revealed that hemodialysis [hazard ratio (HR): 1.9; 95% confidence interval (CI): 1.01-5.28; P=0.04] runoff grade 0 (HR: 2.9; 95% CI: 1.02-10.9; P=0.04), lesion length>200mm (HR: 3.9; 95% CI: 1.1-13.7; P=0.03), and calcium score per 100 increase (HR: 1.05; 95% CI: 1.02-1.08; P<0.01) were predictors of clinically driven target lesion revascularization. As per receiver operating characteristic analysis, the best cutoff value of target lesion calcium score for target lesion revascularization was206. A high femoropopliteal artery calcium score might increase loss of patency and the risk for clinically driven target lesion revascularization.

GW28-e0220 Correlation Between Protein Kinase C Activity and Anterior Tibial Artery Calcification Score in Patients with Diabetic Foot Amputation

To observe the relationship between Protein Kinase C (PKC) activity and anterior tibial artery calcification score in patients with diabetic foot. 60 diabetic patients hospitalized for above-knee amputation in the Department of Orthopedics, Affiliated Hospital of Jiangsu University were recruited

Prevalence of Tibial Artery and Pedal Arch Patency by Angiography in Patients With Critical Limb Ischemia and Noncompressible Ankle Brachial Index.

Approximately 20% of patients undergoing ankle brachial index testing for critical limb ischemia have noncompressible vessels because of tibial artery calcification. This represents a clinical challenge in determining tibial artery patency. We sought to identify the prevalence of tibial artery and pedal arch patency by angiography in these patients. One hundred twenty-five limbs (of 89 patients) with critical limb ischemia and ankle brachial index ≥1.4 who underwent lower extremity angiograms within 1 year were included. Reviewers of angiography were blinded to results of physiological testing. Tibial artery vessels were classified as completely occluded, significantly stenosed (≥50%), or patent (<50% stenosis). The sensitivity of toe brachial index and pulse volume recording to predict tibial artery disease was also determined. Of 125 limbs with noncompressible ankle brachial index, 72 (57.6%) anterior tibial and 80 (64%) posterior tibial arteries were occluded. Another 23 (18.4%) anterior tibial and 13 (10.4%) posterior tibial arteries had ≥50% stenosis. Pulse volume recording was moderate to severely dampened in 54 of 119 (45.4%) limbs. Toe brachial index <0.7 was found in 75 of 83 (90.4%) limbs. Moderate to severe pulse volume recording dampening was 43.6% sensitive, whereas toe brachial index <0.7 was 89.7% sensitive in diagnosing occluded or significantly stenotic tibial artery disease. The pedal arch was absent or incomplete in 86 of 103 (83.5%) limbs. Among patients with critical limb ischemia and noncompressible ankle brachial index results, the prevalence of occlusive tibial and pedal arch disease is very high. Toe brachial index <0.7 is more sensitive in diagnosing occluded and significantly stenotic tibial artery disease in these patients compared with ankle pulse volume recording.

Semiquantitative assessment of tibial artery calcification by computed tomography angiography and its ability to predict infrapopliteal angioplasty outcomes

Tibial artery calcification (TAC) is associated with increased risk of amputation and mortality in peripheral artery disease. We sought to investigate whether the severity of TAC based on semiquantitative analysis of computed tomography angiography (CTA) can predict outcomes of endovascular therapy in patients with critical limb ischemia. We reviewed medical records of 124 patients who underwent lower extremity CTA before intervention. Based on CTA, TAC severity was categorized into three groups: minimal calcification (MC; n= 43), intermediate calcification (IC;n= 36), or extensive calcification (EC; n= 45). Immediate and late outcomes of infrapopliteal interventions were compared, and predictors of the outcomes were investigated. The categorized severity of target TAC correlated with the log-transformed TAC score (r= 0.873; P< .001). The EC group was younger and had more diabetes and chronic kidney disease compared with the MC or IC group (all P< .001). The technical success was lower in the EC group (71.1%) than in the MC (95.3%) or IC (91.7%) group (P= .001). The survival free of unplanned amputations at 2years was significantly lower in the EC group (58.9%) than in the MC (79.0%) or IC (95.3%) group (P< .001). Extensive TAC was an independent predictor of technical success (hazard ratio, 0.02; 95%confidence interval, 0.00-0.45; P= .014) and unplanned amputation (hazard ratio, 9.90; 95% confidence interval, 2.05-47.75; P= .004). The categorized severity of TAC by semiquantitative analysis of CTA correlated with TAC score, and extensive TAC was associated with a lower technical success rate of angioplasty and an increased incidence of unplanned amputation.

Abstract 724: Effect of Arterial Calcification on Lower Extremity Ischemia Score is Independent of Occlusive Disease

Objective: Calcification in lower extremity arteries is associated with a higher risk of amputation and may reflect the amount of atherosclerotic plaque in lower extremity vessels. The association between calcification, occlusive disease, and severity of ischemia, however, has not been explored. We tested the hypothesis that the association between calcification and worsening limb status was mediated by concomitant occlusive disease. Methods: Rutherford ischemia categories, tibial artery calcification (TAC) scores, and the extent of occlusive disease were measured in 276 patients with or without symptomatic peripheral artery disease. Other factors included age, sex, race, and history of diabetes, tobacco use, hypertension, or hyperlipidemia. Patients with severe renal insufficiency (eGFR &lt;30) and patients with aortoiliac disease or acute ischemia were excluded. Multivariable ordinal logistic regression models were constructed using Rutherford ischemia categories (0 - 6) as the dependent variable. Results: When both asymptomatic and symptomatic patients were included in our model, tobacco use, hypertension, occlusion index, and TAC scores were independently associated with increasing Rutherford categories. In multivariate analyses involving only those patients with symptomatic PAD, only the tibial calcification score (OR 2.06 (1.39-3.06), p&lt;0.01) and tobacco use (OR 2.69 (1.03-6.99), p=0.04) maintained an independent association with worsening ischemia categories. Conclusions: Calcification is associated with worsening lower extremity ischemia categories in a way that is independent of the extent of arterial occlusive disease. Further research aimed at understanding the contribution of arterial calcification to ischemia in PAD is warranted, as are efforts to develop treatments to control it.

Association of cardiovascular and biochemical risk factors with tibial artery calcification.

The cardiovascular risk factors that contribute to coronary calcification have been extensively studied while those related to tibial artery calcium are less well defined. We sought to determine the associations between cardiovascular risk factors and tibial artery calcification in a cohort of patients with and without significant peripheral atherosclerosis. A total of 222 patients without end-stage renal disease were identified in a prospectively maintained database containing tibial artery calcification (TAC) scores, and demographic, cardiovascular, and biochemical risk factor information. Patients with prevalent tibial artery calcification were more likely to be older, male, and have a history positive for hypertension, hyperlipidemia, diabetes, and tobacco use. Patients with an abnormal ankle-brachial index (ABI) or symptoms of peripheral artery disease (PAD) were also more likely to have higher calcium values. In analyses using multivariable logistic regression, age, gender, diabetes, and tobacco use maintained their association with prevalent tibial calcification while hypertension, hyperlipidemia and body mass index did not. These associations remained when PAD was added to the model. After adjusting for relevant cardiovascular risk factors, we found that only abnormal ABI, current PAD symptoms, and lower serum calcium values were associated with the presence of tibial artery calcification. In conclusion, in patients without end-stage renal disease, tibial artery calcification has risk factors that are similar but not identical to those for coronary artery calcification and peripheral atherosclerosis.

TCT-521 Impact of tibial artery calcification pattern on the outcomes of below the knee intervention

Tibial artery calcification (TAC) has been reported to be associated with increased risk of amputation. However, there are little available data on the outcomes after below the knee (BTK) intervention according to the severity of TAC. In this study, we aimed to investigate the relationship of the

The relationship between characteristics of calcinosis of the arteries of the lower extremities and the severity of distal neuropathy in the patients with diabetes mellitus

Aim. To estimate the degree of arterial calcinosis in the distal segments of the lower extremities in the patients presenting with diabetes mellitus (DM) and varying severity of distal diabetic polyneuropathy (DPN). Materials and methods. The study involved 61 patients with DM ( 21 men and 40 women, mean age 51.4 +- 11.68 years) of whom 27 suffered DM1 and 34 DM2. Group 1 was comprised of 37 patients with diabetic osteoarthropathy (DOAP), group 2 included 13 patients with severe DPN, and group 3 11 patients having moderate DPN. All the patients underwent comprehensive laboratory and instrumental examination including measurement of peripheral sensitivity and electromyography. The degree of arterial calcinosis in the distal segments of the lower extremities was determined using multispiral computed tomography (MSCT) with the calculation of the Agatston tibial artery calcification scores. Results. The groups were matched for the patients' age, duration of disease, total cholesterol and creatinin levels, and glomerular filtration rate. Moreover, the patients of groups 1 and 2 were matched for the functional state of nerve fibers in the lower extremities and were significantly different in respect to this characteristic from the patients of group 3. Median of the Agatston tibial artery calcification scores in group 1 was 365.4 (min - 0, max - 1600) and in group 2 2.7 (min - 0, max - 74.6). Groups 1 and 2 were comparable in terms of the degree of calcinosis and were significantly different from group 3 (p &lt; 0.05 1 vs 3; p &lt; 0.005 2 vs 3). The Agatston tibial artery calcification scores negatively correlated with the motor response (r = -0.3; p &lt; 0.05) and vibrational sensitivity (r = -0.4, p &lt; 0.01). Conclusion. Results of the study suggest the leading role of DPN in the development and progression of arterial calcinosis in the distal segments of the lower extremities in the patients with diabetes mellitus.

Association of foot ulcer with tibial artery calcification is independent of peripheral occlusive disease in type 2 diabetes

AimsTo determine the relationship between foot ulcers, arterial calcification, and peripheral occlusive disease in patients with type 2 diabetes. MethodsWe performed a cross-sectional study on 162 patients with type 2 diabetes who underwent assessment of tibial artery calcification (TAC) by non-contrasted CT scan. Peripheral artery occlusive disease was assessed by angiography. Foot status including the presence or absence of ulcers was documented at presentation. A multivariable logistic regression model was used to evaluate the association between foot ulcers, arterial calcification, and the extent of peripheral atherosclerotic occlusive disease. ResultsPatients with foot ulcers (N=31) were more likely to be older and have a history of tobacco use. They were also more likely to have higher TAC scores (median [IQR]: 4324.6 [609.9, 11163.6] vs. 9.4 [0.0, 343.9], P<0.001) and more advanced peripheral artery occlusive disease (occlusion index 5.5 [4.8, 6.4] vs. 2.2 [1.0, 3.6], P<0.001). Foot ulcer was strongly associated with elevated TAC scores in a multivariable regression model (odds ratio [95% CI]=2.76 [1.61, 4.75], P=0.0002). ConclusionsThere is a strong association between arterial calcification and diabetic foot ulcers that persists after adjusting for the extent of atherosclerosis in patients with type 2 diabetes.

Association of Foot Ulcers with Tibial Artery Calcification is Independent of Plaque Burden in Type 2 Diabetes

Association of Foot Ulcers with Tibial Artery Calcification is Independent of Plaque Burden in Type 2 Diabetes

Tibial Artery Calcification as a Marker of Amputation Risk in Patients With Peripheral Arterial Disease

The purpose of this study was to evaluate the relationship between calcification in tibial arteries, the degree of limb ischemia, and the near-term risk of amputation. Determining the amputation risk in patients with peripheral arterial disease (PAD) remains difficult. Developing new measures to identify patients who are at high risk for amputation would allow for targeted interventions and focused trials aimed at limb preservation. Two hundred twenty-nine patients underwent evaluation by history, arterial Doppler, and multislice computed tomography of the lower extremities. We then explored the relationship between a tibial artery calcification (TAC), traditional risk factors for PAD, limb status at presentation, and near-term amputation risk. Increased age and traditional atherosclerosis risk factors were associated with higher TAC scores. Patients with critical limb ischemia had the highest TAC scores, and increasing TAC scores were associated with worsening levels of limb ischemia in ordinal regression analysis. Receiver-operator characteristic analysis suggested that the TAC score predicted amputation better than the ankle-brachial index (ABI). Symptomatic patients with a TAC score greater than 400 had a significantly increased risk of amputation. In Cox regression analysis, there was a strong association between the TAC score and the risk of major amputation that remained after adjustment for traditional risk factors and the ABI. In patients presenting with PAD, the TAC score is associated with the stage of disease and it identifies those who are at high risk for amputation better than traditional risk factors and an abnormal ABI.

Falsely elevated ankle pressures in severe leg ischaemia: The pole test—An alternative approach

Ankle-branchial pressure indices (ABPIs), measured by sphygmomanometer and Doppler probe, are an accepted index of chronic leg ischaemia. However, tibial artery sclerosis or calcification decreases compliance, producing falsely elevated cuff occlusion pressures. Arterial cannulation is invasive and impractical, but by elevating the foot and measuring the height at which the Doppler signal disappears, ankle systolic pressure in mmHg can be derived. Using an 8MHz Doppler apparatus and calibrated pole, ankle systolic pressures measured by sphygmomanometer and elevation were compared in 49 severely ischaemic legs (40 patients). ABPIs were derived by dividing ankle systolic pressure by brachial pressure. Median (interquartile range) ABPI assessed by sphygmomanometry was 0.46 (0.35-0.56). Median ABPI measured by leg elevation was significantly lower at 0.21 (0.14-0.30), p < 0.0001, Wilcoxon. In 20 patients undergoing in situ vein bypass grafting, direct transducer-derived pressure measurements were obtained. Median ABPI for this method was 0.15 (0.11-0.27). No significant difference was found when compared with ABPIs derived by elevation, median 0.2 (0.13-0.31), p = 0.324, however median ABPI measured by sphygmomanometry was significantly higher at 0.37 (0.27-0.6), p = 0.0008. Correlation of elevation with transducer-assessed pressure measurements (r = 0.88) was closer than with cuff-derived measurements (r = 0.69). Pressures derived by leg elevation provide a more accurate index of severe leg ischaemia than sphygmomanometry, although the technique is limited to assessing pressures of less than approximately 60 mmHg. Falsely elevated ABPIs may underestimate the extent of disease in patients assessed for vascular reconstruction.