PMID- 36898509
OWN - NLM
STAT- MEDLINE
DCOM- 20230626
LR  - 20231124
IS  - 1097-6809 (Electronic)
IS  - 0741-5214 (Linking)
VI  - 78
IP  - 1
DP  - 2023 Jul
TI  - Iliac artery calcification score stratifies mortality risk estimation in patients 
      with chronic limb-threatening ischemia undergoing revascularization.
PG  - 184-192
LID - S0741-5214(23)00430-5 [pii]
LID - 10.1016/j.jvs.2023.02.019 [doi]
AB  - OBJECTIVE: Patients with chronic limb-threatening ischemia (CLTI) are at high 
      risk for adverse limb outcomes and mortality. Using the Vascular Quality 
      Initiative (VQI) prediction model to estimate mortality after revascularization 
      can assist with clinical decision-making. We aimed to improve the discrimination 
      of the 2-year VQI risk calculator by incorporating a common iliac artery (CIA) 
      calcification score based on computed tomography scans. METHODS: This was a 
      retrospective analysis of patients who underwent infrainguinal revascularization 
      for CLTI from January 2011 to June 2020 and had a computed tomography scan of the 
      abdomen/pelvis 2 years before or up to 6 months after revascularization. CIA 
      calcium morphology, circumference, and length were scored. Bilateral scores were 
      summed for the total calcium burden (CB) score, which was trichotomized (mild, 
      0-15; moderate, 16-19; severe, 20-22). The VQI CLTI model was used to categorize 
      patients as low, medium, or high risk for mortality. RESULTS: A total of 131 
      patients with a mean age of 69+/-12 years were included in the study, and 86 (66%) 
      were men. CB scores were mild in 52 (40%), moderate in 26 (20%), and severe in 53 
      (40%) patients. Older patients (P = .0002) and those with coronary artery disease 
      (P = .06) had higher CB scores. Patients with severe CB scores were more likely 
      to undergo infrainguinal bypass compared with those with mild or moderate CB 
      scores (P = .006). The 2-year VQI mortality risk was calculated to be low in 102 
      (78%), medium in 23 (18%), and high in 6 (4.6%) patients. In the "low-risk" VQI 
      mortality subgroup, 46 (45%) patients had mild, 18 (18%) had moderate, and 38 
      (37%) had severe CB scores, and patients with severe CB scores had significantly 
      higher risk of mortality compared with those with mild or moderate scores (hazard 
      ratio, 2.5; 95% confidence interval, 1.2-5.1; P = .01). In this "low-risk" VQI 
      mortality subgroup, CB score further stratified the risk of mortality (P = .04). 
      CONCLUSIONS: Higher total CIA calcification was significantly associated with 
      mortality in patients undergoing infrainguinal revascularization for CLTI, and 
      preoperative assessment of CIA calcification may help with perioperative risk 
      stratification and guide clinical decision making in this population.
CI  - Copyright (c) 2023 Society for Vascular Surgery. Published by Elsevier Inc. All 
      rights reserved.
FAU - Huynh, Cindy
AU  - Huynh C
AD  - Division of Vascular and Endovascular Surgery, Department of Surgery, Brigham and 
      Women's Hospital, Boston, MA; Division of Vascular and Endovascular Surgery, 
      Department of Surgery, University of California, San Francisco, San Francisco, 
      CA. Electronic address: chuynh8@bwh.harvard.edu.
FAU - Liu, Iris
AU  - Liu I
AD  - Division of Vascular and Endovascular Surgery, Department of Surgery, University 
      of California, San Francisco, San Francisco, CA.
FAU - El Khoury, Rym
AU  - El Khoury R
AD  - Division of Vascular and Endovascular Surgery, Department of Surgery, University 
      of California, San Francisco, San Francisco, CA.
FAU - Zhou, Bo
AU  - Zhou B
AD  - Department of Neurology, University of California, San Francisco, San Francisco, 
      CA.
FAU - Braun, Hillary
AU  - Braun H
AD  - Department of Surgery, University of California, San Francisco, San Francisco, 
      CA.
FAU - Conte, Michael S
AU  - Conte MS
AD  - Division of Vascular and Endovascular Surgery, Department of Surgery, University 
      of California, San Francisco, San Francisco, CA.
FAU - Hiramoto, Jade
AU  - Hiramoto J
AD  - Division of Vascular and Endovascular Surgery, Department of Surgery, University 
      of California, San Francisco, San Francisco, CA.
LA  - eng
PT  - Journal Article
DEP - 20230308
PL  - United States
TA  - J Vasc Surg
JT  - Journal of vascular surgery
JID - 8407742
RN  - SY7Q814VUP (Calcium)
SB  - IM
MH  - Male
MH  - Humans
MH  - Middle Aged
MH  - Aged
MH  - Aged, 80 and over
MH  - Female
MH  - *Chronic Limb-Threatening Ischemia
MH  - Risk Factors
MH  - Risk Assessment
MH  - Retrospective Studies
MH  - Calcium
MH  - Iliac Artery/diagnostic imaging/surgery
MH  - *Peripheral Arterial Disease/diagnostic imaging/surgery
MH  - Treatment Outcome
MH  - Limb Salvage/methods
MH  - Ischemia/diagnostic imaging/surgery
MH  - Chronic Disease
OTO - NOTNLM
OT  - Calcification score
OT  - Infrainguinal revascularization
OT  - Mortality prediction
OT  - Peripheral artery disease
EDAT- 2023/03/11 06:00
MHDA- 2023/06/26 06:41
CRDT- 2023/03/10 19:27
PHST- 2022/12/18 00:00 [received]
PHST- 2023/02/26 00:00 [revised]
PHST- 2023/02/27 00:00 [accepted]
PHST- 2023/06/26 06:41 [medline]
PHST- 2023/03/11 06:00 [pubmed]
PHST- 2023/03/10 19:27 [entrez]
AID - S0741-5214(23)00430-5 [pii]
AID - 10.1016/j.jvs.2023.02.019 [doi]
PST - ppublish
SO  - J Vasc Surg. 2023 Jul;78(1):184-192. doi: 10.1016/j.jvs.2023.02.019. Epub 2023 
      Mar 8.