Quantification of arterial calcification in peripheral artery disease and its association with amputation and/or mortality: A systematic review

Jenny Woo; Arash Fereydooni; Janhavi Patel; Anoushka Lakshmi; Sujin Lee; Amber Trickey; Shipra Arya

doi:10.1177/1358863X251334572

Quantification of arterial calcification in peripheral artery disease and its association with amputation and/or mortality: A systematic review

Vasc Med. 2025 May 14:1358863X251334572. doi: 10.1177/1358863X251334572. Online ahead of print.

Authors

Jenny Woo¹, Arash Fereydooni², Janhavi Patel³, Anoushka Lakshmi⁴, Sujin Lee⁵, Amber Trickey⁶, Shipra Arya²

Affiliations

¹ Department of Molecular and Cell Biology, College of Letters & Science, UC Berkeley, Berkeley, CA, USA.
² Department of Surgery, Division of Vascular Surgery, Stanford University School of Medicine, Palo Alto, CA, USA.
³ Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
⁴ San Jose State University, San Jose, CA, USA.
⁵ Department of Surgery, Division of Vascular Surgery, Massachusetts General Hospital, Boston, MA, USA.
⁶ S-SPIRE Center, Stanford University, Palo Alto, CA, USA.

PMID: 40366061
DOI: 10.1177/1358863X251334572

Abstract

Arterial calcification is prevalent in peripheral artery disease (PAD), especially among patients with advanced age, diabetes, or renal disease. Peripheral arterial calcium score (PACS) is an emerging tool to quantify calcification in peripheral arteries and predict outcomes such as amputation and mortality. This systematic review evaluates PACS methodologies and its association with these adverse outcomes. In a comprehensive search of Embase, MEDLINE, and PubMed from January 1991 to January 2025, 1092 studies were retrieved, of which 17 met the inclusion criteria. Computed tomography and X-ray imaging were the main imaging modalities used to detect calcification through a variety of PACS. A higher PACS was linked to increased risk of amputation and/or mortality. PACS holds potential for predicting outcomes in PAD, particularly amputation and mortality. Standardization of PACS methods is needed to enhance its clinical utility and integration into practice.

Keywords: amputation; calcification; peripheral artery disease (PAD); peripheral calcium score; survival.

Publication types

Review