Precision Imaging Evaluation and Clinical Application Progress of Vascular Calcification in Lower Extremity Peripheral Artery Disease.

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Abstract

Lower extremity peripheral artery disease (PAD) affects a large and growing population worldwide and imposes a substantial clinical burden, particularly among older adults and patients with diabetes, chronic kidney disease, and other cardiovascular risk factors.Vascular calcification is a common and clinically important feature of PAD. It can impair diagnostic accuracy, reduce vascular compliance, increase procedural difficulty during endovascular therapy, and adversely affect long-term outcomes, including restenosis, limb loss, and mortality. Therefore, accurate assessment of calcification is essential for risk stratification, treatment planning, and prognostic evaluation.Although advances in imaging have improved the detection and characterization of lower extremity arterial calcification, several challenges remain. Current imaging approaches are limited by inconsistent scoring standards, heterogeneous CT thresholds, incomplete differentiation between intimal and medial calcification, insufficient detection of active microcalcification, and limited evidence linking imaging findings to treatment selection and post-intervention outcomes. This review summarizes the pathophysiological basis of lower extremity arterial calcification in PAD, recent progress in multimodal imaging evaluation, and the clinical application of imaging findings in endovascular treatment planning. We further discuss imaging-guided vessel preparation strategies, current translational limitations, and future directions, including standardized scoring systems, prospective outcome-based validation, artificial intelligence-assisted quantification, and molecular imaging of active calcification.

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