Calcium score of iliac vessels and relative sparing of the external iliac artery could recommend surgical arterial graft selection

Background: Calcified plaque build-up can increase the risk of subsequent vascular complications in pelvic solid organ transplantation and vascular bypass procedures. Objectives: To assess the atherosclerotic calcification of pelvic vessels by measuring Agatston score and comparing it among abdominal aorta, common iliac artery (CIA), external iliac artery (EIA), and common femoral artery (CFA). Patients and Methods: We retrospectively reviewed the unenhanced computed tomography scans of 197 patients from August 2016 to March 2018. Using calcium-scoring software, we examined the distribution map of calcified plaques, focusing on four different arterial segments-the abdominal aorta, the common iliac artery (CIA), the external iliac artery (EIA), and the common femoral artery (CFA)-to determine which one showed the least mural calcification. Results: A total of 197 patients (118 men, 79 women) with a mean age of 61.19 ± 10.8 years were included in this study. The right EIA segment had the lowest average calcification score (92.1 ± 18.2), including 180 cases (91.4%) of zero calcification, followed by 178 cases (90.4%) of zero calcification in the left EIA. When adjustments were made for age, gender, smoking status, diabetes, hypertension and hyperlipidemia, the odds ratio (OR) of the left EIA for reaching a higher calcium score level was 1.19 (P = 0.44) times greater than the reference group (right EIA). The ratio was markedly higher in the abdominal aorta segment (OR = 146.7.4, P < 0.001), followed by the right CIA (OR = 42.5, P < 0.001), the left CIA (OR = 27.3, P < 0.001), the right CFA (OR = 3.96, P < 0.001), and the left CFA (OR = 3.51, P < 0.001). Conclusion: The study demonstrates a significantly less calcific plaque burden in EIA compared to the adjacent arterial bed.