title: 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.
authors.affiliation: Prairie Heart Institute, St. John's Hospital, Springfield, IL.
authors.forename: Krishna J
authors.initials: KJ
authors.lastname: Rocha-Singh
authors.forename: Thomas
authors.initials: T
authors.lastname: Zeller
authors.forename: Michael R
authors.initials: MR
authors.lastname: Jaff
mesh_terms: D000818:Animals; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D050380:Monckeberg Medial Calcific Sclerosis / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index; D061205:Vascular Calcification / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy
keywords: atherosclerosis; peripheral artery disease; vascular calcification