Abstract：
OBJECTIVE: The aim of this study was to investigate whether intimal arterial calcification (IAC) and medial arterial calcification (MAC) are correlated with the various clinical outcomes following endovascular therapy (EVT) for peripheral arterial disease (PAD).
METHODS: This single-center retrospective study comprised 154 consecutively hospitalized individuals with PAD who underwent EVT for de novo femoral-popliteal calcific lesions from January 2016 to July 2021. The predominant calcification patterns of IAC and MAC were assessed using a semi-quantitative computed tomography scoring system. The Kaplan-Meier method and Cox regression were conducted to evaluate the correlations between calcification patterns and medium- to long-term outcomes.
RESULTS: The distribution of calcification patterns was as follows: IAC in 111 patients (72%) and MAC in 43 patients (28%). No remarkable variation was noted between the IAC and MAC groups regarding age (P = .84) and gender (P = .23). The MAC group indicated lower rates of 4-year primary patency, assisted primary patency, secondary patency, and amputation-free survival (AFS) compared with the IAC group (24% ± 7% vs 40% ± 6%; P = .003; 30% ± 8% vs 51% ± 6%; P = .001; 51% ± 8% vs 65% ± 5%; P = .004; and 43% ± 9% vs 76% ± 5%; P < .001, respectively). There was no significant difference in the rate of freedom from clinically driven target lesion revascularization between the MAC and IAC groups (63% ± 10% vs 73% ± 5%; P = .26). Stepwise multivariable Cox regression analysis demonstrated that MAC was associated with poor patency (hazard ratio, 1.81; 95% confidence interval, 1.12-2.93; P = .016) and AFS (hazard ratio, 2.80; 95% confidence interval, 1.52-5.16; P = .001).
CONCLUSIONS: Compared with IAC, MAC is independently associated with lower medium- to long-term patency and AFS after EVT for de novo femoral-popliteal occlusive lesions.
METHODS: This single-center retrospective study comprised 154 consecutively hospitalized individuals with PAD who underwent EVT for de novo femoral-popliteal calcific lesions from January 2016 to July 2021. The predominant calcification patterns of IAC and MAC were assessed using a semi-quantitative computed tomography scoring system. The Kaplan-Meier method and Cox regression were conducted to evaluate the correlations between calcification patterns and medium- to long-term outcomes.
RESULTS: The distribution of calcification patterns was as follows: IAC in 111 patients (72%) and MAC in 43 patients (28%). No remarkable variation was noted between the IAC and MAC groups regarding age (P = .84) and gender (P = .23). The MAC group indicated lower rates of 4-year primary patency, assisted primary patency, secondary patency, and amputation-free survival (AFS) compared with the IAC group (24% ± 7% vs 40% ± 6%; P = .003; 30% ± 8% vs 51% ± 6%; P = .001; 51% ± 8% vs 65% ± 5%; P = .004; and 43% ± 9% vs 76% ± 5%; P < .001, respectively). There was no significant difference in the rate of freedom from clinically driven target lesion revascularization between the MAC and IAC groups (63% ± 10% vs 73% ± 5%; P = .26). Stepwise multivariable Cox regression analysis demonstrated that MAC was associated with poor patency (hazard ratio, 1.81; 95% confidence interval, 1.12-2.93; P = .016) and AFS (hazard ratio, 2.80; 95% confidence interval, 1.52-5.16; P = .001).
CONCLUSIONS: Compared with IAC, MAC is independently associated with lower medium- to long-term patency and AFS after EVT for de novo femoral-popliteal occlusive lesions.
摘要：
目的：探讨内膜动脉钙化（IAC）和内侧动脉钙化（MAC）是否与周围动脉疾病（PAD）血管内治疗（EVT）后的各种临床结果相关。
方法：这项单中心回顾性研究纳入了154名连续住院的PAD患者，这些患者于2016年1月至2021年7月因新的股-pop钙化性病变接受EVT治疗。使用半定量计算机断层扫描评分系统评估IAC和MAC的主要钙化模式。采用Kaplan-Meier法和Cox回归方法评估钙化模式与中长期结局之间的相关性。
结果：钙化模式的分布如下：IAC为111例（72％），MAC为43例（28％）。在年龄（p=0.84）和性别（p=0.23）方面，IAC和MAC组之间没有明显差异。MAC组显示4年初级通畅率较低，辅助初级通畅，与IAC组相比，继发性通畅性和无截肢生存率(24±7%vs.40±6%,p=.003；30±8%vs.51±6%,p=.001;51±8%vs.65±5%,p=.004；43±9%vs.76±5%，p<.001)。MAC组和IAC组之间临床驱动的靶病变血运重建的发生率没有显着差异（63±10％vs.73±5%；p=.26）。逐步多变量Cox回归分析表明，MAC与通畅性差相关(风险比[HR]，1.81；95%CI，1.12-2.93；p=0.016）和AFS（HR，2.80；95%CI，1.52-5.16；p=.001）。
结论：与IAC相比，对于从头股-pop闭塞性病变，在EVT后，MAC与较低的中长期通畅性和AFS独立相关。
方法：这项单中心回顾性研究纳入了154名连续住院的PAD患者，这些患者于2016年1月至2021年7月因新的股-pop钙化性病变接受EVT治疗。使用半定量计算机断层扫描评分系统评估IAC和MAC的主要钙化模式。采用Kaplan-Meier法和Cox回归方法评估钙化模式与中长期结局之间的相关性。
结果：钙化模式的分布如下：IAC为111例（72％），MAC为43例（28％）。在年龄（p=0.84）和性别（p=0.23）方面，IAC和MAC组之间没有明显差异。MAC组显示4年初级通畅率较低，辅助初级通畅，与IAC组相比，继发性通畅性和无截肢生存率(24±7%vs.40±6%,p=.003；30±8%vs.51±6%,p=.001;51±8%vs.65±5%,p=.004；43±9%vs.76±5%，p<.001)。MAC组和IAC组之间临床驱动的靶病变血运重建的发生率没有显着差异（63±10％vs.73±5%；p=.26）。逐步多变量Cox回归分析表明，MAC与通畅性差相关(风险比[HR]，1.81；95%CI，1.12-2.93；p=0.016）和AFS（HR，2.80；95%CI，1.52-5.16；p=.001）。
结论：与IAC相比，对于从头股-pop闭塞性病变，在EVT后，MAC与较低的中长期通畅性和AFS独立相关。
