{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:42:41Z","timestamp":1760060561113,"version":"build-2065373602"},"reference-count":34,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T00:00:00Z","timestamp":1757289600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Unit of Vascular and Endovascular Surgery, Department of Cardio-Thoracic-Vascular Surgery, S. Anna University Hospital of Ferrara"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Medial arterial calcification (MAC) is a vascular disorder that affects the arterial media layer. It represents a predictor of major adverse limb events in patients affected by diabetes mellitus (DM). This single-center retrospective observational study investigates whether ultrasound (US) detection of MAC in below-the-knee (BTK) vessels represents a negative predictor of major adverse cardiovascular events (MACE) in asymptomatic patients. Methods: In 2019, 584 patients, referred to the Vascular Surgery Unit for lower limb US, were examined by the same operator, who assessed the presence of BTK MAC. The primary outcome was the rate of MACE during a 5-year follow-up period. The secondary outcomes included the development of peripheral arterial disease (PAD), the overall survival rates, lower limb revascularizations, and major amputations. Results: MAC in BTK vessels was highlighted in 239 patients (MAC+) who exhibited a younger age (p &lt; 0.001), DM (p &lt; 0.001), and chronic kidney disease (CKD) (p = 0.048). The 345 subjects without MAC (MAC\u2212) showed prior myocardial infarction (p &lt; 0.001), stroke (p = 0.034), and smoking habits (p &lt; 0.001). After propensity score matching, the MAC+ group presented a higher risk of MACE (HR: 1.84; CI: 1.01\u20133.38; p = 0.047) during a median follow-up of 57 months. Age (HR: 1.06; CI: 1.01\u20131.12) and MAC (HR: 1.22; CI: 1.06\u20131.57) were independently associated with MACE. New diagnoses of PAD mainly occurred in the MAC\u2212 group (p &lt; 0.001). No differences were observed in major amputations, revascularization procedures, or overall survival rates. Conclusions: Ultrasound detection of BTK MAC was associated with the presence of DM and CKD and with a 1.8-fold increased risk of developing a MACE within 5 years in asymptomatic patients.<\/jats:p>","DOI":"10.3390\/diagnostics15172273","type":"journal-article","created":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T11:51:12Z","timestamp":1757332272000},"page":"2273","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Ultrasound Detection of Below-the-Knee Medial Arterial Calcifications in Asymptomatic Patients Is an Early Negative Predictor of Major Adverse Cardiovascular Events"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8589-5154","authenticated-orcid":false,"given":"Giulia","family":"Baldazzi","sequence":"first","affiliation":[{"name":"School of Vascular Surgery, University of Ferrara, 44121 Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5763-3069","authenticated-orcid":false,"given":"Nicola","family":"Lamberti","sequence":"additional","affiliation":[{"name":"Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martina","family":"Saladini","sequence":"additional","affiliation":[{"name":"School of Medicine, Department of Translational Medicine and for Romagna, University of Ferrara, 44121 Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Cristina","family":"Taddia","sequence":"additional","affiliation":[{"name":"Unit of Vascular and Endovascular Surgery, Department of Cardio-Thoracic-Vascular Surgery, S. Anna University Hospital of Ferrara, 44124 Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valentina","family":"Ficarra","sequence":"additional","affiliation":[{"name":"Unit of Vascular and Endovascular Surgery, Department of Cardio-Thoracic-Vascular Surgery, S. Anna University Hospital of Ferrara, 44124 Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9476-6434","authenticated-orcid":false,"given":"Fabio","family":"Manfredini","sequence":"additional","affiliation":[{"name":"Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy"},{"name":"Program of Vascular Rehabilitation and Exercise Medicine, S. Anna University Hospital of Ferrara, 44124 Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron Thomas","family":"Fargion","sequence":"additional","affiliation":[{"name":"Unit of Vascular and Endovascular Surgery, Department of Cardio-Thoracic-Vascular Surgery, S. Anna University Hospital of Ferrara, 44124 Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"M\u00f6nckeberg, J. (1903). VIII. \u00dcber die Reine Mediaverkalkung der Extremit\u00e4tenarterien und Ihr Verhalten zur Arteriosklerose. (aus dem Pathologisch-Anatomischen Institut des Allgem. Krankenhauses Hainburg-Eppendorf.), De Gruyter. 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