title: Semiquantitative assessment of tibial artery calcification by computed tomography angiography and its ability to predict infrapopliteal angioplasty outcomes.
abstract: OBJECTIVE
  Tibial artery calcification (TAC) is associated with increased risk of amputation and mortality in peripheral artery disease. We sought to investigate whether the severity of TAC based on semiquantitative analysis of computed tomography angiography (CTA) can predict outcomes of endovascular therapy in patients with critical limb ischemia.
  
  
  METHODS
  We reviewed medical records of 124 patients who underwent lower extremity CTA before intervention. Based on CTA, TAC severity was categorized into three groups: minimal calcification (MC; n = 43), intermediate calcification (IC; n = 36), or extensive calcification (EC; n = 45). Immediate and late outcomes of infrapopliteal interventions were compared, and predictors of the outcomes were investigated.
  
  
  RESULTS
  The categorized severity of target TAC correlated with the log-transformed TAC score (r = 0.873; P < .001). The EC group was younger and had more diabetes and chronic kidney disease compared with the MC or IC group (all P < .001). The technical success was lower in the EC group (71.1%) than in the MC (95.3%) or IC (91.7%) group (P = .001). The survival free of unplanned amputations at 2 years was significantly lower in the EC group (58.9%) than in the MC (79.0%) or IC (95.3%) group (P < .001). Extensive TAC was an independent predictor of technical success (hazard ratio, 0.02; 95% confidence interval, 0.00-0.45; P = .014) and unplanned amputation (hazard ratio, 9.90; 95% confidence interval, 2.05-47.75; P = .004).
  
  
  CONCLUSIONS
  The categorized severity of TAC by semiquantitative analysis of CTA correlated with TAC score, and extensive TAC was associated with a lower technical success rate of angioplasty and an increased incidence of unplanned amputation.
authors.affiliation: Division of Cardiology, Cardiovascular Research Institute, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: In Sook
authors.initials: IS
authors.lastname: Kang
authors.affiliation: Division of Cardiology, Cardiovascular Research Institute, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Wonkyung
authors.initials: W
authors.lastname: Lee
authors.affiliation: Department of Radiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Byoung Wook
authors.initials: BW
authors.lastname: Choi
authors.affiliation: Division of Cardiology, Cardiovascular Research Institute, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Donghoon
authors.initials: D
authors.lastname: Choi
authors.affiliation: Division of Cardiology, Cardiovascular Research Institute, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Myeong-Ki
authors.initials: MK
authors.lastname: Hong
authors.affiliation: Division of Cardiology, Cardiovascular Research Institute, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Yangsoo
authors.initials: Y
authors.lastname: Jang
authors.affiliation: Division of Cardiology, Cardiovascular Research Institute, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address: ygko@yuhs.ac.
authors.forename: Young-Guk
authors.initials: YG
authors.lastname: Ko
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D017130:Angioplasty / Q000009:adverse effects; D001331:Automation; D000072226:Computed Tomography Angiography; D016638:Critical Illness; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome; D061205:Vascular Calcification / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*