Aortic calcifications on chest radiographs associated with survival after lower extremity minor amputation

Objective: This study evaluates the prevalence and prognostic value of aortic calcifications (ACs) on chest radiographs of patients undergoing lower extremity minor amputation. This study hypothesized that ACs are common and associated with inferior post-amputation survival outcomes. Methods: This retrospective cohort study included 383 patients who underwent minor lower limb amputation after undergoing a preoperative chest radiograph within 3 months prior to amputation. The presence of ACs was assessed using three classification systems: the Symeonidis system, the Tian system, and a novel AV classification introduced here. Each system has either three or four categories for grading the extent of AC. The associations between these classification systems and overall survival (OS), amputation-free survival (AFS), and leg salvage (LS) were evaluated using Kaplan-Meier curves and Cox regression. Results: A total of 62.1% of patients (n = 238) had ACs. Severe AC (21.9%; n = 84) was significantly associated with a higher risk of poorer OS (hazard ratio [HR], 3.165; 95% confidence interval [CI], 2.191-4.573), AFS (HR, 2.972; 95% CI, 2.096-4.214), and LS (HR, 2.495; 95% CI, 1.279-4.865). Severe AC was associated with impaired OS and AFS but not with LS in the multivariable model. Conclusions: ACs are common and clinically relevant findings for patients undergoing minor amputation. As a simple and widely evaluable marker of systemic atherosclerotic burden, the detection of AC may aid in preoperative risk stratification and treatment selection in limb-threatening conditions.