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Semiquantitative assessment of tibial artery calcification by computed tomography angiography and its ability to predict infrapopliteal angioplasty outcomes

 In Sook Kang  ;  Wonkyung Lee  ;  Byoung Wook Choi  ;  Donghoon Choi  ;  Myeong-Ki Hong  ;  Yangsoo Jang  ;  Young-Guk Ko 
 JOURNAL OF VASCULAR SURGERY, Vol.64(5) : 1335-1343, 2016 
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Aged ; Aged, 80 and over ; Amputation ; Angioplasty*/adverse effects ; Automation ; Computed Tomography Angiography* ; Critical Illness ; Disease-Free Survival ; Female ; Humans ; Ischemia/diagnostic imaging* ; Ischemia/physiopathology ; Ischemia/therapy* ; Kaplan-Meier Estimate ; Limb Salvage ; Male ; Medical Records ; Middle Aged ; Peripheral Arterial Disease/diagnostic imaging* ; Peripheral Arterial Disease/physiopathology ; Peripheral Arterial Disease/therapy* ; Predictive Value of Tests ; Radiographic Image Interpretation, Computer-Assisted ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Treatment Outcome ; Vascular Calcification/diagnostic imaging* ; Vascular Calcification/physiopathology ; Vascular Calcification/therapy*
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.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Ko, Young Guk(고영국) ORCID logo https://orcid.org/0000-0001-7748-5788
Jang, Yang Soo(장양수) ORCID logo https://orcid.org/0000-0002-2169-3112
Choi, Dong Hoon(최동훈) ORCID logo https://orcid.org/0000-0002-2009-9760
Choi, Byoung Wook(최병욱) ORCID logo https://orcid.org/0000-0002-8873-5444
Hong, Myeong Ki(홍명기) ORCID logo https://orcid.org/0000-0002-2090-2031
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