Background: Diabetes mellitus (DM) is one of the strongest predictors of peripheral arterial occlusive disease, and a significant risk factor for the progression of an asymptomatic disease or claudication into critical limb ischemia (CLI). (CLI) is the most advanced stage of peripheral arterial occlusive disease. The prognosis is poor, with amputation rates up to be 30%. Objective: To assess the calcium burden of infragenicular native vessels in diabetic patients, to clarify its impact on primary and secondary patency rate (1ry and 2ry) and efficacy of endovascular management. Patients and Method: Between 2018 and 2020, data from 30 consecutive diabetic patients with tibial arteries calcifications, at Al-Zahra’a University Hospital. All patients underwent lower extremity computed tomographic angiography (CTA) before the intervention. Based on CTA, tibial artery calcification (TAC) severity was categorized into three groups: minimal calcification (12 patients), intermediate calcification (10 patients), or extensive calcification (8 patients), with a total number of 42 limbs (12 patients were affected bilaterally). Immediate and late outcomes of the interventions were compared. Results: There was a high correlation between calcification of tibial arteries and both DM and smoking. Claudication, rest pain, and major tissue loss presentation between all groups were higher in patients with extensive calcifications. Technical success rate was 88.1%, and primary patency rate was 83.3%. The 2-year patency rate for minimal calcification was 100%, 92.9% in the intermediate group, and 71.4% in the extensive group. Conclusion: The outcomes of endovascular treatment (EVT) for patients with TAC were acceptable, with better technical success in minimal and intermediate calcification than extensive calcified lesions.
