Tibial Artery Calcification as a Marker of Amputation Risk in Patients With Peripheral Arterial Disease
Raul J. Guzman, MD*,*,
D. Marshal Brinkley, MD*,
Paul M. Schumacher, MD*,
Rafe M.J. Donahue, PhD ,
Holly Beavers, RN* and
Xiao Qin, MD
* Division of Vascular Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
Guangxi Medical University First Affiliated Hospital, Guangxi, China.
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Figure 1 TAC
Noncontrasted multislice computed tomography showing a patient without (A) and with (B) significant tibial artery calcification (TAC). Arrows identify calcified tibial arteries.
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Figure 2 TAC Scores by Limb Status
Tibial artery calcification (TAC) scores in patients without (control group) and with peripheral arterial disease (claudication and critical limb ischemia [CLI]). Each dot represents a single patient. Open circles represent patients who subsequently underwent major amputation. Lines represent median for each group.
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Figure 3 Clinical Presentation by TAC Range
Patients were divided according to tibial artery calcification (TAC) categories (0 to 10, 10 to 1,000, and >1,000). Bars represent the number of patients with no disease (red bars, control group), claudication (blue bars), or critical limb ischemia (CLI) (black bars).
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Figure 4 ROC Analysis
Receiver-operator characteristic (ROC) curves for the predictive value of tibial artery calcification (TAC) and ankle-brachial index (ABI) on major amputation (A) and on major and minor amputation (B). The black line represents the ROC curve for TAC score. The blue line represents ROC curve for ABI. The red line represents no effect. AUC = area under the curve.
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Figure 5 Major Amputation Events According to TAC Score for Patients With PAD
Symptomatic vascular patients were stratified by tibial artery calcification (TAC) scores >400 or <400. Kaplan-Meier curves were derived for major amputation-free survival. The p value is derived using the log-rank test. Number of patients at risk at each time point is listed on the bottom. PAD = peripheral arterial disease.
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