ArticleAnnals of surgery2025
Vascular Calcification Amplifies Limb Flexion-Induced Arterial Deformations and Causes Intermittent Vessel Pinching.
Article in Annals of surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- High Embolic Risk with Orbital Atherectomy for Calcified Peripheral Artery Disease.Annals of biomedical engineering · 2026Article
- Biomechanical Characterization of Porcine Lower Limb Arteries for Preclinical Evaluation of Peripheral Vascular Devices.Annals of biomedical engineering · 2026Article
- Calcification of the elastic component: the impact on the cardiovascular system.Frontiers in cardiovascular medicine · 2025Review
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Authors and funding
7 authors.
Funding
Abstract
objectiveWe aimed to investigate the role of arterial calcification in intensifying femoropopliteal artery (FPA) deformation under limb flexion.
backgroundPeripheral artery disease (PAD) is characterized by reduced blood flow to the lower extremities, often associated with FPA obstructions. Arterial calcification is a key contributor to poor outcomes in PAD. It stiffens arteries and may exacerbate kinking and lumen collapse during limb flexion.
methods84 bent-leg and 84 straight-leg computed tomography angiography (CTA) reconstructions from 32 PAD patients were used to quantify arterial foreshortening, tortuosity, bending, and lumen area reduction. Calcification was characterized using calcium volume, circumferential involvement, and Hounsfield Unit (HU) values.
resultsArterial foreshortening during limb flexion averaged 6±2% in walking postures and 9±3% in sitting postures, while tortuosity values were 0.08±0.02 and 0.14±0.03, respectively. Minimum arterial bending radii were 49±53 mm in walking and 14±10 mm in sitting postures, with median radii of 60±50 mm and 20±15 mm, respectively. Calcified FPAs exhibited significantly sharper bending angles (84±17° vs. 105±13°), and a 2.4-fold greater lumen area reduction (10.17 mm² vs. 4.24 mm²) under limb flexion compared to non-calcified arteries.
conclusionsArterial calcification significantly amplifies limb flexion-induced deformations, leading to sharper bending, greater lumen narrowing, and increased risk of intermittent flow obstruction. These findings highlight the importance of bent-leg imaging to identify high-risk arterial segments and guide targeted interventions, such as plaque modification or stent designs optimized to mitigate arterial kinking.
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