Calcium in Peripheral Artery Disease: Characteristics, Consequences and Prevalence by Vascular Territory and by Type of Calcium
Arterial calcification is highly prevalent in peripheral artery disease (PAD), particularly in those with critical limb ischemia (CLI). Calcification is associated with symptoms, adverse outcomes and mortality. In patients undergoing endovascular revascularization, the presence of calcium creates numerous challenges, as well as increases the rate of procedural complications.
Both intimal and medial artery calcium (MAC) are found in the lower limb arteries. While equally prevalent in the femoropopliteal and infrapopliteal arteries, the type of calcification varies by vascular territory. MAC is more prevalent in the arteries below-the-knee.
While coronary artery calcium has been studied extensively, much less is known about calcium in the lower limb arteries. With recent publication of numerous studies investigating calcium in PAD and CLI patients, this knowledge gap has been reduced. In particular, clinical and genetic research has focused on medial artery calcium, which is considered to be an independent cause of PAD.
This report reviews the characteristics, consequences and prevalence of calcium in PAD and CLI.
The prevalence and severity of calcium in CLI patients and limbs is estimated for the 2020-2040 period. The percent prevalence of calcium is estimated for the three vascular territories: aortoiliac (AI), femoropopliteal (FP) and infrapopliteal (IP). Estimates by type of calcium, medial and intimal, in each vascular territory are included.
All estimates are provided in 5-year increments.
Calculations are based on THE SAGE GROUP’s CLI estimates for the Rutherford 4-6 patients in combination with the percentage prevalence of calcium and type of calcium derived from the literature review.
Intermittent claudication (IC) patients also have a high prevalence of arterial calcium. However, because of the scarcity of data on calcium in IC patients, detailed calcium estimates are not provided.
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