Medial artery calcification in peripheral artery disease

Abstract

Medial artery calcification (MAC) is a distinct, highly regulated process that is often identified in small and mid-sized arteries of the lower extremities. It is associated with advanced age, diabetes, and chronic kidney disease. MAC often occurs in conjunction with atherosclerotic occlusive disease in lower extremity arteries, and when seen together or in isolation, long-term limb outcomes are negatively affected. In patients with peripheral artery disease (PAD), the extent of MAC independently correlates with major amputation and mortality rates, and it predicts poor outcomes after endovascular interventions. It is associated with increased arterial stiffness and decreased pedal perfusion. New endovascular methods aimed at treating calcified lower-extremity lesions may improve our ability to treat patients with limb-threatening ischemia. Although recent developments have increased our understanding of the mechanisms contributing to MAC, further investigations are needed to understand the role of medial calcification in PAD, and to develop strategies aimed at improving patient outcomes.

Peripheral Artery Disease: Molecular Mechanisms and Novel Therapies

“…16 Renal disease, DM, inflammatory disorders, warfarin use, and age have each been reported to be risk factors for MAC. 17 Vascular calcification is mediated by regulated pathways that contribute to bone formation, osteogenic differentiation of stem cells, and transdifferentiation of vascular smooth muscle cells into osteochondrocyte-like cells in response to environmental cues. 16 Lessons have also been drawn from genetic calcification disorders that manifest with extracoronary vascular disease, such as arterial calcification due to deficiency of CD73.…”

The cardiovascular changes underlying a low cardiac output with exercise in patients with type 2 diabetes mellitus

“… Hematoxylin and eosin stain of tibial arteries from a patient with intimal (A) and medial (B) calcification. L denotes lumen, I denotes intima, and M denotes media (from Kim and Guzman, 2023 ). Patients with diabesity often suffer from intimal atheromatosis, but notably patients with T2DM also often suffer from medial calcification stiffening conductance arteries and increasing afterload to the heart.…”

Vascular Calcification: Molecular Networking, Pathological Implications and Translational Opportunities

“…Medial calcification, also termed Mönckeberg sclerosis, occurs preferentially along the elastic lamina and is usually identified in small and medium-sized arteries of the lower extremities. It is associated with advanced age, diabetes, and chronic kidney disease (CKD), and, unlike intimal calcification, it occurs independently of atherosclerosis [ 32 , 33 , 34 ]. It is a process similar to intramembranous bone formation, involving the transdifferentiation of vascular smooth muscle cells (VSMCs) to mineralizing cells.…”