PMID- 33054496
OWN - NLM
STAT- MEDLINE
DCOM- 20210624
LR  - 20221207
IS  - 1545-1550 (Electronic)
IS  - 1526-6028 (Linking)
VI  - 28
IP  - 2
DP  - 2021 Apr
TI  - A Novel Scoring System for Small Artery Disease and Medial Arterial Calcification 
      Is Strongly Associated With Major Adverse Limb Events in Patients With Chronic 
      Limb-Threatening Ischemia.
PG  - 194-207
LID - 10.1177/1526602820966309 [doi]
AB  - PURPOSE: To evaluate the roles of small artery disease (SAD) and medial arterial 
      calcification (MAC) in patients with chronic limb-threatening ischemia (CLTI) and 
      to identify any correlation between these factors and peripheral artery disease 
      (PAD) or outcomes after treatment. MATERIALS AND METHODS: A retrospective review 
      was conducted of 259 limbs with tissue loss among 223 CLTI patients (mean age 
      72.2+/-11.4 years; 194 men) having an angiographic foot vessel study, foot 
      radiography, and at least 6 months of follow-up after intervention. SAD and MAC 
      were quantified using a 3-level score (0=absent, 1=moderate, 2=severe) based on 
      angiography for SAD and foot radiographs for MAC. The MAC score was validated and 
      compared with the SAD score, evaluating their associations with PAD distribution 
      and clinical outcomes. RESULTS: Based on the MAC score, the 259 limbs were 
      classified as 55 group 0 (21.2%), 89 group 1 (34.4%), and 115 group 2 (44.4%). 
      The SAD score stratified the 259 limbs as 67 group 0 (25.9%), 76 group 1 (29.3%), 
      and 116 group 2 (44.8%). Interobserver reproducibility of the MAC score was high 
      (correlation coefficient 0.96). Sensitivity and specificity of the MAC score in 
      detecting SAD was 100% and 98.1%, respectively, in SAD groups 0 and 2 vs 99.1% 
      and 92.7%, respectively, for SAD group 1. PAD was more proximal in MAC and SAD 
      groups 0 and more distal in groups 1 and 2. Both MAC and SAD scores were able to 
      predict clinical endpoints. Multivariable analysis demonstrated that the MAC 
      score represents an independent risk factor for adverse limb events. CONCLUSION: 
      SAD and MAC must be considered expressions of the same obstructing disease, able 
      to adversely impact the fate of CLTI patients. SAD and MAC scores are powerful 
      prognostic indicators of major adverse limb events in CLTI patients.
FAU - Ferraresi, Roberto
AU  - Ferraresi R
AD  - Peripheral Interventional Unit, San Carlo Clinic, Paderno Dugnano, Milan, Italy.
FAU - Ucci, Alessandro
AU  - Ucci A
AUID- ORCID: 0000-0001-6375-3171
AD  - Vascular Surgery Unit, University of Parma, Italy.
FAU - Pizzuto, Alessandra
AU  - Pizzuto A
AD  - Pediatric Cardiology and GUCH Unit, FTGM, Massa, Italy.
FAU - Losurdo, Fabrizio
AU  - Losurdo F
AD  - Diabetic Foot Clinic, San Carlo Clinic, Paderno Dugnano, Milan, Italy.
FAU - Caminiti, Maurizio
AU  - Caminiti M
AD  - Diabetic Foot Clinic, San Carlo Clinic, Paderno Dugnano, Milan, Italy.
FAU - Minnella, Daniela
AU  - Minnella D
AD  - Diabetic Foot Clinic, San Carlo Clinic, Paderno Dugnano, Milan, Italy.
FAU - Casini, Andrea
AU  - Casini A
AD  - Vascular Surgery Unit, San Carlo Clinic, Paderno Dugnano, Milan, Italy.
FAU - Clerici, Giacomo
AU  - Clerici G
AD  - Diabetic Foot Clinic, San Carlo Clinic, Paderno Dugnano, Milan, Italy.
FAU - Montero-Baker, Miguel
AU  - Montero-Baker M
AD  - Division of Vascular and Endovascular Surgery, Baylor College of Medicine, 
      Houston, TX, USA.
FAU - Mills, Joseph
AU  - Mills J
AD  - Division of Vascular and Endovascular Surgery, Baylor College of Medicine, 
      Houston, TX, USA.
LA  - eng
PT  - Journal Article
DEP - 20201015
PL  - United States
TA  - J Endovasc Ther
JT  - Journal of endovascular therapy : an official journal of the International 
      Society of Endovascular Specialists
JID - 100896915
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Amputation, Surgical
MH  - Arteries
MH  - Chronic Disease
MH  - Humans
MH  - *Ischemia/diagnostic imaging/surgery
MH  - Limb Salvage
MH  - Male
MH  - Middle Aged
MH  - *Peripheral Arterial Disease/diagnostic imaging/surgery
MH  - Reproducibility of Results
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Treatment Outcome
OTO - NOTNLM
OT  - atherosclerosis
OT  - big artery disease
OT  - chronic kidney disease
OT  - chronic limb-threatening ischemia
OT  - critical limb ischemia
OT  - diabetes
OT  - medial artery calcification
OT  - peripheral artery disease
OT  - small artery disease
EDAT- 2020/10/16 06:00
MHDA- 2021/06/25 06:00
CRDT- 2020/10/15 17:07
PHST- 2020/10/16 06:00 [pubmed]
PHST- 2021/06/25 06:00 [medline]
PHST- 2020/10/15 17:07 [entrez]
AID - 10.1177/1526602820966309 [doi]
PST - ppublish
SO  - J Endovasc Ther. 2021 Apr;28(2):194-207. doi: 10.1177/1526602820966309. Epub 2020 
      Oct 15.