Association of iliofemoral calcium score and major vascular complications within the first year after lower limb endovascular revascularization

Raul Devia-Rodriguez; Maikel Derksen; Mostafa El Moumni; Kristian de Groot; Issi R Vedder; Clark J Zeebregts; Reinoud P H Bokkers; Robert A Pol; Jean-Paul P M de Vries; Richte C L Schuurmann

doi:10.1016/j.avsg.2024.11.009

Association of iliofemoral calcium score and major vascular complications within the first year after lower limb endovascular revascularization

Ann Vasc Surg. 2024 Nov 22:S0890-5096(24)00699-X. doi: 10.1016/j.avsg.2024.11.009. Online ahead of print.

Affiliations

¹ Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. Electronic address: r.devia.rodriguez@umcg.nl.
² Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
³ Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
⁴ Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

PMID: 39581313
DOI: 10.1016/j.avsg.2024.11.009

Abstract

Background: The accumulation of calcium load in peripheral lower extremity arteries has been associated with increased severity of peripheral arterial 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).

Methods: A cohort of CLTI patients subjected to endovascular revascularization between 2005 and 2017 at a tertiary referral center were categorized into two groups. The complication group experienced one of the composite outcomes (reintervention, above-the-ankle amputation, and/or all-cause mortality within one 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[mm³]/length[cm]) at three 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.

Results: 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).

Conclusions: Patients with a high calcium load in the ilio-femoral arteries are at increased risk of major adverse events during one year after endovascular revascularization. The calcium score, derived from contrast-enhanced CT scans, holds potential utility in decision making for CLTI patients.

Keywords: Peripheral arterial diseases; chronic limb threatening ischemia; contrast enhanced computed tomography; length adjusted score; major adverse events.