The Clinical Study Of The Risk Factors For Calcification Vary Among The Different Sections Of The Lower Extremity Artery In Patients With Symptomatic Peripheral Arterial Disease

Objective: To explore the risk factors of calcification in different segments of lower extremity arteries in patients with symptomatic peripheral arterial disease(PAD),and analyze the correlation between calcification and the degree of stenosis in corresponding segments.Method: This study enrolled symptomatic PAD patients who underwent lower extremity computed tomography angiography(CTA)examination in our hospital from September 2017 to March 2018.Patients’ baseline data were recorded.The lower extremity arterial calcification score(LEACS)and lower extremity arterial index(LEAI)representing the extent of arterial stenosis were measured on non-contrast and contrast CT,respectively.Spearman test was used to analyze the correlation between LEACS and LEAI in all lower extremity and all segments,and to analyze the correlation between LEACS in all segments and total LEACS.By using the median LEACSs(total,aortoiliac,femoropopliteal,and infrapopliteal arteries)as cutoffs,the patients were allocated into high and low calcification groups,and the intergroup comparisons were performed using a t test and chi-square test.The risk factors for arterial calcification in the total lower extremity and at each segments were assessed by univariate linear regression analysis,and the independent risk factors were further determined by multivariate linear regression analysis.Result: 1.A total of 103 patients were eventually included in this study,and baseline data and imaging materials are complete.2.The total LEACS was associated with the total LEAI(r = 0.437,P < 0.001).As for each arterial section,the LEACSs of the aortoiliac artery(r = 0.297,P = 0.002),femoropopliteal artery(r = 0.473,P < 0.001)and infrapopliteal artery(r = 0.521,P < 0.001)were all correlated with the LEAI,but their correlation was relatively weak in the aortoiliac artery.3.In the correlation analysis between LEACS in all segments and total LEACS,the aortoiliac arterial segment(r = 0.865,P < 0.001),the femoropopliteal arterial segment (r = 0.892,P < 0.001)and the infrapopliteal arterial segment(r = 0.799,P < 0.001)were highly correlated with total LEACS,of which the femoropopliteal arterial segment had the highest correlation.A high correlation was found between the left(r = 0.967,P < 0.001)/ right(r = 0.970,P < 0.001)LEACS and the total LEACS,and it was also found between left LEACS and right LEACS(r = 0.917,P<0.001).4.In the intergroup comparisons,there were no differences in baseline data between the two calcification groups of the total lower extremity.In the analysis of each segment of the lower extremities,the proportion of hypertension patients in the high calcification score group of the aortoiliac arterial segment was higher,while the proportion of patients aged > 60 years and those with diabetes mellitus in the high-calcification group of the femoral and inferior genicular segments was higher.5.Univariate analysis showed that age > 60 years affected the LEACSs in the total lower extremity and all sections.Hypertension(P = 0.021)and diabetes(P = 0.048)were risk factors for total LEACS.In different sections of the lower extremities,hypertension(P = 0.034)is a risk factor of LEACS in the aortoiliac arterial segment,diabetes is a risk factor of LEACS in the femoropopliteal arterial segment(P = 0.009)and the infrapopliteal arterial segment(P = 0.014),and male sex(P = 0.013)are also a risk factor of LEACS in the infrapopliteal arterial segment.Multivariate analysis demonstrated that,after adjustment for age,the above relationships were maintained for the above sections,but not in the total lower extremity artery.Conclusion: 1.The LEACS is associated with the LEASI in all arterial sections,but that of the aortoiliac artery was relatively weak.2.In clinical application,the use of LEACS in a certain segment of the lower extremity artery may also replace the total LEACS,especially the femoropopliteal artery segment.3.Traditional cardiovascular risk factors have different effects on calcification among the various sections of the lower extremity artery,suggesting that the mechanism of vascular calcification in different segments of the lower extremity is different.