Robbert B M Wiggers, Iris M Harmsen, Madeleine Kok, Joost A van Herwaarden, Pim A de Jong, Gert J de Borst, Constantijn E V B Hazenberg
{"title":"A systematic review of the association between arterial calcification on preoperative imaging and clinical outcomes in peripheral arterial disease.","authors":"Robbert B M Wiggers, Iris M Harmsen, Madeleine Kok, Joost A van Herwaarden, Pim A de Jong, Gert J de Borst, Constantijn E V B Hazenberg","doi":"10.1016/j.jvs.2025.06.029","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Peripheral arterial disease may lead to chronic limb-threatening ischemia, which is associated with major amputation and mortality. Early detection of patients at risk for poor outcomes could allow for patient-tailored prevention and treatment strategies, averting these adverse events. Coronary and aortic calcification have previously been shown to predict future cardiovascular events and mortality. The objective of this review was to investigate the association between peripheral artery calcification and clinical outcomes in symptomatic peripheral arterial disease patients, either in the natural course or after revascularization.</p><p><strong>Data sources and review methods: </strong>A systematic search in PubMed, Embase and Cochrane CENTRAL up until 1 September 2024 yielded 2963 records. Studies were included if they (1) were written in English, (2) reported original data, (3) recruited symptomatic peripheral arterial disease patients (with claudication or chronic limb-threatening ischemia), (4) quantified arterial calcification in the infrarenal aorta and/or distal arteries with a calcium score based on preoperative or alternative non-invasive imaging and (5) compared clinical outcomes between patients with a range of quantitative or semiquantitative calcification assessments. Risk of bias was assessed using the QUIPS method.</p><p><strong>Results and conclusion: </strong>51 studies (N = 10 522 patients) met the inclusion criteria. 12 studies (N = 1058) used quantitative scores, 37 used semiquantitative scores (N = 9208) and 2 used both (N = 256). Mean follow-up of included studies ranged between 6 and 46 months. A clear trend towards a higher rate of major adverse limb events, amputation, major adverse cardiovascular events and mortality was found with increasing calcium scores. However, relatively low sample sizes and heterogeneity in calcium scoring methods, patient population and performed interventions warrant cautious interpretation of these results. Further standardization of calcium scoring and follow-up studies in larger cohorts are needed to confirm these associations and facilitate implementation of calcium scoring in clinical practice.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":" ","pages":""},"PeriodicalIF":3.9000,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Vascular Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jvs.2025.06.029","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: Peripheral arterial disease may lead to chronic limb-threatening ischemia, which is associated with major amputation and mortality. Early detection of patients at risk for poor outcomes could allow for patient-tailored prevention and treatment strategies, averting these adverse events. Coronary and aortic calcification have previously been shown to predict future cardiovascular events and mortality. The objective of this review was to investigate the association between peripheral artery calcification and clinical outcomes in symptomatic peripheral arterial disease patients, either in the natural course or after revascularization.
Data sources and review methods: A systematic search in PubMed, Embase and Cochrane CENTRAL up until 1 September 2024 yielded 2963 records. Studies were included if they (1) were written in English, (2) reported original data, (3) recruited symptomatic peripheral arterial disease patients (with claudication or chronic limb-threatening ischemia), (4) quantified arterial calcification in the infrarenal aorta and/or distal arteries with a calcium score based on preoperative or alternative non-invasive imaging and (5) compared clinical outcomes between patients with a range of quantitative or semiquantitative calcification assessments. Risk of bias was assessed using the QUIPS method.
Results and conclusion: 51 studies (N = 10 522 patients) met the inclusion criteria. 12 studies (N = 1058) used quantitative scores, 37 used semiquantitative scores (N = 9208) and 2 used both (N = 256). Mean follow-up of included studies ranged between 6 and 46 months. A clear trend towards a higher rate of major adverse limb events, amputation, major adverse cardiovascular events and mortality was found with increasing calcium scores. However, relatively low sample sizes and heterogeneity in calcium scoring methods, patient population and performed interventions warrant cautious interpretation of these results. Further standardization of calcium scoring and follow-up studies in larger cohorts are needed to confirm these associations and facilitate implementation of calcium scoring in clinical practice.
期刊介绍:
Journal of Vascular Surgery ® aims to be the premier international journal of medical, endovascular and surgical care of vascular diseases. It is dedicated to the science and art of vascular surgery and aims to improve the management of patients with vascular diseases by publishing relevant papers that report important medical advances, test new hypotheses, and address current controversies. To acheive this goal, the Journal will publish original clinical and laboratory studies, and reports and papers that comment on the social, economic, ethical, legal, and political factors, which relate to these aims. As the official publication of The Society for Vascular Surgery, the Journal will publish, after peer review, selected papers presented at the annual meeting of this organization and affiliated vascular societies, as well as original articles from members and non-members.