Correlation Between Degree of Calcium Scoring and Abdominal Aortic Aneurysm Endovascular Repair Outcomes
Samuel Nussbaum, Mira Shoukry, Karen Jeong, Natalia Acebal, David Sella, Lauren Alexander, Tambi Jarmi, Houssam Farres, Albert Hakaim
Mayo Clinic Florida, Jacksonville, FL
Background: Calcium scoring, which quantifies arterial calcification seen on computed tomography (CT) scans, is regularly used as a predictor of cardiovascular events in coronary circulation; however, calcium scoring obtained from other arterial distributions such as the aorta and the iliac arteries may be suitable as a predictor of outcomes, especially following vascular interventions. Studies that investigate using calcium scoring as a risk stratification tool in patients undergoing endovascular repair for abdominal aortic aneurysm (AAA) are scarce. This study aims to explore the correlation between the degree of aortic and iliac arteries calcification using calcium scoring and the post-operative outcomes of patients with AAA following endovascular repair.
Methods: A retrospective review of patients who were diagnosed with AAA and underwent repair at Mayo Clinic Florida from January 2008 to June 2020 was performed. Patient demographics, risk factors, and postoperative outcomes were collected. Eligible patients were defined as having a non-enhanced abdominal and pelvic CT dated before their intervention. Calcium deposits were scored beginning just beneath the celiac artery and ending at the origin of the inferior epigastric artery in the external iliac and sciatic notch in the internal iliac. The scores were analyzed parallel to post-operative survival and incidence of an endoleak.
Results: A total of 98 patients met the eligibility criteria. Of those, 36 died over a median follow-up time of 17 months. An unadjusted Cox hazard ratio was created for correlation between calcium scoring and endovascular intervention outcomes. Total calcium score, aneurysm score, and left iliac artery score were significantly related to mortality outcome (p<.05). The hazard ratios for total calcium score, aneurysm score, and left iliac artery score were 1.126, 1.298, 1.340 respectively (Table 1). For every 5000-unit increase in calcium score, the risk of mortality increases by 13% in total score, 30% in aneurysm score, and 34% in left iliac score. The endoleak group did have greater median calcium scores (1591.2) compared to the non-endoleak group (889.2); however, this difference was not statistically significant (p=0.062).
Conclusion: Increased calcium scoring of the abdominal aorta and iliac arteries associates with increased mortality in patients undergoing endovascular aortic repair of AAA. Larger sample sizes in future studies could be considered to study if there is any correlation between calcium scoring and endoleak.
| Covariate | Hazard Ratio (95% CI) | P-Value |
| Total Calcium Score | 1.126 (1.032, 1.227) | 0.007 |
| Aneurysm Score | 1.298 (1.101, 1.530) | 0.002 |
| Above Anuerysm Score | 1.627 (0.976, 2.713) | 0.062 |
| Left Iliac Score | 1.340 (1.004, 1.788) | 0.047 |
| Right Iliac Score | 1.327 (0.972, 1.812) | 0.075 |
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