Distribution of Medial Calcification and Luminal Stenosis in Symptomatic Patients with Hemodialysis and Peripheral Artery Disease Using 3D Computed Tomography Angiography

 Vascular calcification, including medial calcification and intimal calcification inducing luminal stenosis, of the lower extremities are commonly associated with in hemodialysis (HD), whereas their distribution has not been assessed comprehensively. Three-dimensional (3D) computed tomography angiography (CTA) may be a powerful imaging tool for detection of vascular calcification and arterial stenosis with high spatial resolution in patients with HD and peripheral artery disease (PAD).

 The aim of this study was to investigate the distribution of medial calcification and luminal stenosis in symptomatic patients with HD and PAD using 3D CTA.
Patients and

 Forty-seven patients with HD and symptomatic PAD underwent 3D CTA of the lower extremities. We used 3D maximum intensity projection with and without subtraction by precontrast from postcontrast images in order to assess the medial calcification and luminal stenosis in the common, external, and internal iliac arteries, superficial femoral arteries, and lower limb arteries.

 The external iliac artery (EIA) was significantly spared from both medial calcification and luminal stenosis, while the internal iliac, superficial femoral artery (SFA), and tibioperoneal arteries had either arterial disorders.

 The characteristic distribution of medial calcification and luminal stenosis, such as spared EIA and SFA involvement, is observed in patients with HD and symptomatic PAD by 3D CTA.