ARTERIAL CALCIFICATIONS IN CHRONIC LIMB-THREATENING ISCHEMIA: ANALYSIS, PROGNOSIS AND TREATMENT OUTCOME

Abstract

Critical limb-treatening ischemia is caused by a narrowing, or by completely blocked arteries in the legs. As a result, the tissues do not receive enough oxygen and they can die. The prognosis of critical ischemia is still very poor. They mainly die from related vascular diseases of, for example, the coronary arteries and the arteries in the head. In this thesis, several aspects of critical ischemia are investigated. The first aim of this study is to map arterial calcifications of these patients on Computed Tomography (CT) scans in order to better understand the disease and identify the high-risk patients. The second aim of this study focuses more on the treatment of these patients and evaluates the safety and cost-effectiveness of using paclitaxel-coated vascular stents compared to using uncoated vascular stents. In summary, this thesis provides new insights into arteriosclerosis in patients with and without critical ischemia. Arteries in patients with critical ischemia are very severely calcified, both in the legs and in other locations such as the aorta, carotid arteries and arteries in the brain. This is a possible explanation for the high mortality and disease burden in this patient group. Two calcification patterns can be found in the legs; a dominant medial pattern in the lower legs and a dominant intima calcification pattern in the upper legs. Second, this thesis has shown that the use of paclitaxel-coated stents to treat critical ischemia patients with stenosis and occlusion of the lower leg arteries is safe and cost-effective.