Peripheral arterial calcification: Prevalence, mechanism, detection, and clinical implications

Abstract

Vascular calcification (VC), particularly medial (Mönckeberg's medial sclerosis) arterial calcification, is common in patients with diabetes mellitus and chronic kidney disease and is associated with increased cardiovascular morbidity and mortality. Although, the underlying pathophysiological mechanisms and genetic pathways of VC are not fully known, hypocalcemia, hyperphosphatemia, and the suppression of parathyroid hormone activity are central to the development of vessel mineralization and, consequently, bone demineralization. In addition to preventive measures, such as the modification of atherosclerotic cardiovascular risk factors, current treatment strategies include the use of calcium-free phosphate binders, vitamin D analogs, and calcium mimetics that have shown promising results, albeit in small patient cohorts. The impact of intimal and medial VC on the safety and effectiveness of endovascular devices to treat symptomatic peripheral arterial disease (PAD) remains poorly defined. The absence of a generally accepted, validated vascular calcium grading scale hampers clinical progress in assessing the safety and utility of various endovascular devices (e.g., atherectomy) in treating calcified vessels. Accordingly, we propose the peripheral arterial calcium scoring system (PACSS) and a method for its clinical validation. A better understanding of the pathogenesis of vascular calcification and the development of optimal medical and endovascular treatment strategies are crucial as the population ages and presents with more chronic comorbidities.

Recanalization of a Heavily Calcified Chronic Total Occlusion in a Femoropopliteal Artery Using a Wingman Crossing Catheter

“…However, subintimal crossing is not always successful in patients with heavily calcified arteries because dense calcification usually presents in a media as well as an intima. 10) As described in our case…”

Calcium Burden Assessment and Impact on Drug-Eluting Balloons in Peripheral Arterial Disease

“…Only few studies have highlighted the importance of calcium [8,9,15,24] and a satisfactory scientific method to measure calcium level has not been found yet. Maybe this is the reason why calcium and its negative influence has not been systematically described and reported in clinical studies.…”

“…Maybe this is the reason why calcium and its negative influence has not been systematically described and reported in clinical studies. Rocha-Singh recently described a peripheral arterial calcification scoring systems where intimal and medial vessel wall calcification at the target lesion site is assessed by high intensity fluoroscopy and DSA in the AP projection [24].…”

Comparison of Transradial vs Transfemoral Access for Aortoiliac and Femoropopliteal Interventions

“…10,20 The degree of lesion calcification was classified using the Peripheral Academic Research Consortium criteria. 10,21 FA failure was defined as the need to switch to the contralateral femoral artery for any reason to complete the procedure; TRA failure was confirmed if lesion crossing was not achieved and any form of alternative access was required to complete the procedure.…”