Distribution of Vascular Calcification With Attendant Clinical Consequences
Vascular calcification at the carotid vessels is associated with increased risk of stroke (141). Involvement of the proximal aorta can cause a porcelain aorta that can prohibit cardiothoracic surgery (142). Calcification of the coronary arteries has been linked to increased cardiovascular and all-cause mortality and locally may cause increased atherothrombosis. Calcification of the aorta and the distal vessels is associated with increased arterial stiffness. Calcification of the iliofemoral vessels at the site of anastomosis has been associated with graft failure and worse transplantation outcomes (143,144). Calcification of the radial artery and fistula site is more generally associated with early fistula failure (145,146). Calcification of the lower limb arteries is associated with the development of peripheral arterial disease (PAD) (claudication, limb ischemia) as well as arterial stiffness (147,148). Calciphylaxis is a severe and accelerated form of calcification, predominantly localized in the medial layer of skin arterioles and commonly affects the lower limbs but can occur anywhere. CAC = coronary artery calcification.