PMID- 34481900 OWN - NLM STAT- MEDLINE DCOM- 20220221 LR - 20221207 IS - 1097-6809 (Electronic) IS - 0741-5214 (Linking) VI - 75 IP - 1 DP - 2022 Jan TI - Pedal arterial calcification score is associated with the risk of major amputation in chronic limb-threatening ischemia. PG - 270-278.e3 LID - S0741-5214(21)01978-9 [pii] LID - 10.1016/j.jvs.2021.07.235 [doi] AB - OBJECTIVE: The medial arterial calcification (MAC) score is a simple metric that describes the burden of inframalleolar calcification using a plain foot radiograph. We hypothesized that a higher MAC score would be independently associated with the risk of major amputation in patients with chronic limb-threatening ischemia (CLTI). METHODS: We performed a single-institution, retrospective study of 250 patients who had undergone infrainguinal revascularization for CLTI from January 2011 to July 2019 and had foot radiographs available for MAC score calculation. A single blinded reviewer assigned MAC scores of 0 to 5 using two-view minimum plain foot radiographs, with 1 point each for calcification of >2 cm in the dorsalis pedis, plantar, and metatarsal arteries and >1 cm in the hallux and non-hallux digital arteries. RESULTS: The MAC score was 0 in 36%, 1 in 5.2%, 2 in 8.4%, 3 in 14%, 4 in 14%, and 5 in 21%. The MAC score was trichotomized to facilitate analysis and clinical utility (mild, MAC score 0-1; moderate, MAC score 2-4; and severe, MAC score 5). The variables independently associated with a higher MAC score were male sex, diabetes, end-stage renal disease, and the global limb anatomic staging system pedal score. The MAC score was not associated with the Society for Vascular Surgery WIfI (wound, ischemia, foot infection) grade or overall WIfI stage (P = .58). The median follow-up was 759 days (interquartile range, 264-1541 days). A higher MAC score was significantly associated with the risk of major amputation (P < .0001). In a Cox proportional hazards multiple regression model for major amputation that included the trichotomized MAC score, diabetes, end-stage renal disease, and WIfI stage (1-3 vs 4). The MAC score (MAC score 5: hazard ratio [HR], 4.9; 95% confidence interval [CI], 1.9-13.1; P = .001; MAC score 2-4: HR, 3.4; 95% CI, 1.3-8.8; P = .01) and WIfI stage (WIfI stage 4: HR, 2.1; 95% CI, 1.1-3.9; P = .03) were significantly associated with the risk of major amputation. In the subsets of patients with the most advanced WIfI stage of 3 to 4 (191 of 250; 76%) and patients with diabetes (185 of 250; 74%), the MAC score further stratified the risk of major amputation on univariate and multivariate analyses. CONCLUSIONS: The MAC score is a simple, practical tool and a strong independent predictor of major amputation in patients with CLTI. It provides novel clinical data that are currently unmeasured using any validated CLTI staging system. The MAC score is a promising standardized measure of inframalleolar disease burden that can be used in conjunction with the WIfI staging system to help improve outcomes stratification and determine the optimal treatment strategies for patients with CLTI. CI - Copyright (c) 2021 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved. FAU - Liu, Iris H AU - Liu IH AD - Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Francisco, San Francisco, Calif. FAU - Wu, Bian AU - Wu B AD - Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Francisco, San Francisco, Calif. FAU - Krepkiy, Viktoriya AU - Krepkiy V AD - Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Francisco, San Francisco, Calif. FAU - Ferraresi, Roberto AU - Ferraresi R AD - Clinica San Carlo, Paderno Dugnano, Milan, Italy. FAU - Reyzelman, Alexander M AU - Reyzelman AM AD - Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Francisco, San Francisco, Calif. FAU - Hiramoto, Jade S AU - Hiramoto JS AD - Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Francisco, San Francisco, Calif. FAU - Schneider, Peter A AU - Schneider PA AD - Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Francisco, San Francisco, Calif. FAU - Conte, Michael S AU - Conte MS AD - Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Francisco, San Francisco, Calif. FAU - Vartanian, Shant M AU - Vartanian SM AD - Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Francisco, San Francisco, Calif. Electronic address: shant.vartanian@ucsf.edu. LA - eng PT - Journal Article DEP - 20210903 PL - United States TA - J Vasc Surg JT - Journal of vascular surgery JID - 8407742 SB - IM MH - Aged MH - Aged, 80 and over MH - Amputation, Surgical/*statistics & numerical data MH - Angioplasty/*statistics & numerical data MH - Arteries/diagnostic imaging/surgery MH - Chronic Limb-Threatening Ischemia/*surgery MH - Feasibility Studies MH - Female MH - Foot/blood supply/diagnostic imaging MH - Humans MH - Limb Salvage/*statistics & numerical data MH - Male MH - Middle Aged MH - Retrospective Studies MH - Risk Assessment/methods/statistics & numerical data MH - Risk Factors MH - Severity of Illness Index MH - Vascular Calcification/*diagnosis MH - Vascular Patency OTO - NOTNLM OT - Amputation OT - Chronic limb threatening ischemia OT - Foot ulcer OT - Monckeberg medial calcific sclerosis OT - Peripheral arterial disease OT - Vascular calcification EDAT- 2021/09/06 06:00 MHDA- 2022/02/22 06:00 CRDT- 2021/09/05 20:37 PHST- 2020/10/30 00:00 [received] PHST- 2021/07/29 00:00 [accepted] PHST- 2021/09/06 06:00 [pubmed] PHST- 2022/02/22 06:00 [medline] PHST- 2021/09/05 20:37 [entrez] AID - S0741-5214(21)01978-9 [pii] AID - 10.1016/j.jvs.2021.07.235 [doi] PST - ppublish SO - J Vasc Surg. 2022 Jan;75(1):270-278.e3. doi: 10.1016/j.jvs.2021.07.235. Epub 2021 Sep 3.