![noncompressible calcified vessel meaning noncompressible calcified vessel meaning](https://s3.amazonaws.com/prod.tctmd.com/public/styles/large_slide_teaser/public/2014-09/125467.png)
Angiography showed a diffuse narrowing of all the forefoot arteries, with a complete "desert" first toe (B).
Noncompressible calcified vessel meaning for mac#
In order to quantify SAD, a previously described angiographic score was utilized, 2 whereas for MAC we proposed a new calcium score ( Figures 2 and 3).įigure 1: A 72-year-old patient with type 1 diabetes and chronic kidney disease on hemodialysis presented with first toe gangrene (A). To answer this question, we investigated the correlation between SAD and MAC in a cohort of 223 patients with 259 CLTI limbs, who underwent treatment between June 2015 and March 2019. In our daily practice and applying a standardized angiographic protocol of study, 21 we very often observe the coexistence of SAD and MAC in CLTI patients, raising the question if they could be manifestations of the same underlying disease ( Figure 1). 14-18ĭespite this strong association between MAC and CLTI, MAC has been considered by most authors as a "non-obstructive" disease, and the hypothetical "mechanisms of action" connecting MAC and CLTI were supposed to be indirect effects of the arterial wall stiffening: loss of vasomotion and adverse remodeling predisposing to an accelerated vascular aging, atherosclerosis and plaque rupture. 13-18 Moreover, MAC and an elevated ankle brachial index, considered secondary to non-compressible ankle arteries as a consequence of MAC, are associated with clinical manifestations of CLTI, such as foot ulcer, gangrene, and amputation. 12 MAC is a strong marker of future cardiovascular events and death, both in patients with diabetes and CKD. 9-11 MAC tends to affect the arteries diffusely, appearing as "railroad tracks" along the outline of the arterial wall on plain radiography. 7,8 MAC occurs independently of atherosclerosis and is associated with aging, DM and CKD. While BAD is usually treatable by means of bypass or angioplasty, SAD is an untreatable disease, leading to the final failure of the vascular distribution system of the foot, and jeopardizing the fate of the limb, 6 despite any successful BAD treatment.Įxcept for a farsighted observation published in 1967 by Ferrier, SAD was never associated with medial artery calcification (MAC). 3-5 CLTI patients may be found to have either BAD, SAD or a combination of both entities. SAD has been associated with poor clinical outcomes in terms of wound healing, time to healing, limb salvage and survival. 1 PAD is considered a plaque-based, atherosclerotic big artery disease (BAD), however, especially in patients with diabetes mellitus (DM) or chronic kidney disease (CKD), we often observe the presence of small artery disease (SAD), obstructing the below-the-ankle arteries. Small artery disease and medial artery calcification are two sides of the same coin: an epidemic obstructive disease fueled by age, diabetes and dialysis and leading to CLTI.Ĭhronic limb-threatening ischemia (CLTI) is the clinical manifestation of advanced peripheral artery disease (PAD), presenting with rest pain or tissue loss.Atherosclerotic big artery disease is no more the main cause of the clinical manifestations of PAD small artery disease is now a leading actor in chronic limb threatening ischemia.