Footnotes on critical limb ischemia.

n this issue of the Journal, Guzman et al. (1) investigate a ovel approach for identifying patients at risk for amputaion secondary to peripheral arterial disease. This study is he first to use multidetector computed tomography to uantify tibial artery calcification (TAC). The authors dvance the hypothesis that TAC is a measure of the everity of below the knee atherosclerotic disease much in he same way as coronary artery calcification (CAC) reflects he severity of coronary arteriopathy (2). In the lower xtremities, amputations most commonly result from critial limb ischemia (CLI) brought about by multilevel arterial nvolvement. However, the common anatomic denominator hat unites many of these patients is the severity of concomitant ibial arterial disease. Consequently, using TAC as a measure f the index of the severity of tibial disease is reasonable.