Association of arterial calcification with chronic limb ischemia in patients with peripheral artery disease

Zettervall, Sara L.; Marshall, Andre P.; Fleser, Paul S.; Guzman, Raul J.

doi:10.1016/j.jvs.2017.06.086

Cited by 58 publications

(50 citation statements)

References 55 publications

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“…In this study, the total LEACS was associated with the total LEASI, indicating that the extent of arterial stenosis could be better predicted by the degree of calcification. This finding is supported by several similar observations [ 23 , 27 ]. The internal diameter of blood vessels in the normal human body can be maintained through a compensatory increase in arterial perimeter, but Sigrist et al [ 28 ] found that decreased arterial compliance is associated with femoral arterial calcification in dialysis patients, which might eventually lead to vascular stenosis.…”

Section: Discussionsupporting

confidence: 91%

The risk factors for calcification vary among the different sections of the lower extremity artery in patients with symptomatic peripheral arterial disease

Yan

Chang

Liu

2020

BMC Cardiovasc Disord

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Background Peripheral arterial disease (PAD) is associated with considerable mortality and morbidity worldwide. The present study explored the risk factors for arterial calcification among the different sections of the lower extremity in patients with PAD and analyzed their correlations with the extent of arterial stenosis at the corresponding section. Methods This study enrolled symptomatic PAD patients from our hospital from March 2017 to March 2018. The lower extremity arterial calcification score (LEACS) and lower extremity arterial stenosis index (LEASI), representing the extent of arterial stenosis, were measured on computed tomography (CT) and the correlations between them were analyzed using Spearman’s correlation analysis. The relationships between risk factors and calcification were analyzed among the different sections of the lower extremity artery. Results In total, 209 patients were included. The LEACSs of the total lower extremity, aortoiliac artery, and femoropopliteal and infrapopliteal arteries were correlated with the LEASI (all P < 0.05), but their correlation was relatively weak in the aortoiliac artery. Univariate analysis showed that hypertension was associated with the total ( P = 0.019) and aortoiliac ( P = 0.012) LEACSs. Diabetes was related to both femoropopliteal ( P = 0.001) and infrapopliteal ( P = 0.002) LEACSs. The infrapopliteal LEACS was higher in male patients ( P = 0.011). After adjustment for age, the above relationships were maintained among the different sections, but not in the total lower extremity artery. Conclusions The LEACS is associated with the LEASI in all arterial sections, but that of the aortoiliac artery was relatively weak. Different factors have different effects on calcification among the various sections of the lower extremity artery.

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Section: Discussionsupporting

confidence: 91%

The risk factors for calcification vary among the different sections of the lower extremity artery in patients with symptomatic peripheral arterial disease

Yan

Chang

Liu

2020

BMC Cardiovasc Disord

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“… 4 Both intimal and medial calcification contribute to arterial wall stiffness, which leads to the vessel recoil and restenosis seen after endovascular interventions. 2 , 5 – 7 Although considerable progress in endovascular therapy has been made over the past decade, controversy still exists among physicians as to the best endovascular strategy for patients with symptomatic disease of the infrapopliteal arteries, particularly those with significant calcification.…”

Section: Introductionmentioning

confidence: 99%

Safety and Feasibility of Intravascular Lithotripsy for Treatment of Below-the-Knee Arterial Stenoses

2018

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Purpose: To evaluate the safety and feasibility of treating calcified infrapopliteal stenoses using an intravascular lithotripsy (IVL) system. Methods: The Disrupt BTK study was a prospective, nonrandomized, multicenter, feasibility, and safety trial that enrolled 20 patients (mean age 79.0±9.6 years; 14 men) at 3 participating sites (ClinicalTrials.gov identifier NCT02911623). Fifteen patients had Rutherford category 5 ischemia, and all patients had moderate to severe below-the-knee arterial calcification. Patients were treated with the Shockwave Medical Peripheral IVL System and followed for 30 days. The primary safety endpoint was a composite of major adverse events through 30 days defined as death, myocardial infarction, need for emergency surgical revascularization of the target limb, or amputation of the target limb. The primary effectiveness outcome was acute reduction in the percent diameter stenosis. Results: IVL catheter delivery was successful in 19 patients. The composite of major adverse events at 30 days was 0%. The acute reduction in percent diameter stenosis of target lesions was 46.5%. All patients achieved residual diameter stenosis ≤50%. Vascular complications were minimal with only 1 type B dissection reported and 2 stents placed. None of the subjects experienced thrombus formation, abrupt closure, distal embolization, or perforation. There were no device-related complications. Conclusion: The early results of this pilot study demonstrated that calcified, stenotic infrapopliteal arteries can be safely and successfully treated with intravascular lithotripsy.

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“…Abating fatal cardiovascular disease (CVD) events among patients with atherosclerosis, chronic kidney disease, diabetes and the aging population remains an imperative clinical challenge. CVD induces major arterial occlusions and stiffening, which can be largely driven by the development of vascular calcification, and the associated hemodynamic consequences cause high rates of hypertension, myocardial infarction, stroke and lower-limb ischemia [ 1 , 2 ]. The mortality rate of patients with chronic kidney disease (CKD) alone accounts for 50% of premature deaths while additionally patients with peripheral arterial disease are predisposed to lower limb amputations [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Is Matrix Gla Protein Associated with Vascular Calcification? A Systematic Review

Barrett¹,

O’Keeffe²,

Kavanagh³

et al. 2018

Nutrients

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Specific patient cohorts are at increased risk of vascular calcification. Functional matrix-gla protein (MGP), a tissue-derived vitamin K dependent protein, is reported to be an important inhibitor of vascular calcification and may have clinical potential to modify the progression of vascular calcification through regulation of functional MGP fractions. This systematic review examines twenty-eight studies which assess the relationship between circulating protein expressions of MGP species and vascular calcification in different arterial beds. The included studies examined participants with atherosclerosis, chronic kidney disease (CKD), diabetes, healthy participants, vitamin K supplementation, measured plasma vitamin K levels and vitamin K antagonist usage. The current review reports conflicting results regarding MGP fractions with respect to local calcification development indicating that a multifaceted relationship exists between the MGP and calcification. A primary concern regarding the studies in this review is the large degree of variability in the calcification location assessed and the fraction of MGP measured. This review suggests that different underlying molecular mechanisms can accelerate local disease progression within the vasculature, and specific circulating fractions of MGP may be influenced differently depending on the local disease states related to vascular calcification development. Further studies examining the influence of non-functional MGP levels, with respect to specific calcified arterial beds, are warranted.

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Association of arterial calcification with chronic limb ischemia in patients with peripheral artery disease

Abstract: PAC is independently associated with increased ischemia categories in patients with peripheral artery disease. Further research aimed at understanding the relationship between arterial calcification and worsening limb ischemia is warranted.

Cited by 58 publications

References 55 publications

The risk factors for calcification vary among the different sections of the lower extremity artery in patients with symptomatic peripheral arterial disease

The risk factors for calcification vary among the different sections of the lower extremity artery in patients with symptomatic peripheral arterial disease

Safety and Feasibility of Intravascular Lithotripsy for Treatment of Below-the-Knee Arterial Stenoses

Is Matrix Gla Protein Associated with Vascular Calcification? A Systematic Review

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