Iliac Calcium Score thresholds predict cardiovascular and limb-related outcomes in TASC D aortoiliac disease.

Introduction: Extensive lower limb arterial calcification complicates revascularization and is linked to poor outcomes, including limb loss and cardiovascular events. Standardized scoring systems are lacking, particularly in aortoiliac TASC II D lesions. This study evaluated the prognostic value of a CT-based Iliac Calcium Score (ICS) in predicting major adverse limb events (MALE), cardiovascular events (MACE), and all-cause mortality in patients with severe aortoiliac disease. Methods: In this prospective cohort (2013-2024), 109 patients with TASC II D aortoiliac occlusive disease underwent elective revascularization and preoperative CT angiography. Iliac artery calcification was scored semiquantitatively by morphology, circumference, and lesion length. Patients were stratified into low (≤ 36) and high (≥ 37) ICS groups. Outcomes included MALE, MACE, and mortality, analyzed using Kaplan-Meier and Cox regression. Results: The study included 109 patients (95.4% male) with a median follow-up of 67 months. Baseline characteristics were similar across ICS groups, though ICS ≥ 37 was associated with more advanced Rutherford stages ( Conclusion: In patients with extensive TASC II D aortoiliac occlusive disease, an ICS ≥ 37 was independently associated with increased long-term risk of MACE, MALE, and reduced overall survival, despite similar short-term outcomes. These findings support the integration of preoperative calcium scoring as a simple, lesion-specific tool for risk stratification, procedural planning, and personalized postoperative surveillance in complex peripheral arterial disease.