1460-P: Association between Medial Arterial Calcification (MAC) Score in Pedal Arteries and Healing Outcomes in Diabetic Foot Ulcers: A Retrospective Study

Introduction and Objective: Medial arterial calcification (MAC) in pedal arteries is a common finding in people with type 2 diabetes (T2D), which might impair distal perfusion, and contribute to poor wound healing. Understanding its prognostic significance might enhance clinical decision-making in the management of diabetic foot ulcer (DFU).The aim of this study was to assess the relationship between pedal MAC score and wound outcomes in people with T2D with DFUs. Methods: In this retrospective study (n=233; 160 males, mean age 57.1±10.3 yrs) with T2D with DFUs treated between 2015-2025. MAC scores were calculated from the X-ray of the foot (AP and lateral view) and graded as absent (grade 0), mild (grades 1-2) and moderate to severe (grades 3-5). Healing outcomes at 6 months and lower limb amputation (major and minor) were recorded. Results: Healing rates at 6 months declined with increasing MAC scores: 86.4% for MAC 0 (95/110), 74.6% for MAC 1-2 (44/59), and 70.3% for MAC 3-5 (45/64) (p=0.027). Amputation rates were 6.4%, 11.9%, and 20.3%, respectively (p=0.021). Two variables emerged as independent predictors of the outcome.: Higher MAC scores (OR=0.76, p=0.012) and higher duration of ulcer (OR=0.92, p=0.008) were associated with reduced odds of the outcome. Other variables, including age, sex, Wagner grade, peripheral vascular disease, peripheral neuropathy, smoking status, BMI, eGFR, and HbA1c, were not significant contributors in the adjusted model. Conclusion: Greater severity of medial arterial calcification correlates with poorer healing outcomes in people with DFU, suggesting that MAC scoring may serve as a valuable prognostic indicator. Routine assessment of pedal arterial calcification could aid in risk stratification and guide management strategies in diabetic foot care. Disclosure E.B. Jude: Speaker's Bureau; Ended; Sanofi. Research Support; Ended; Abbott Diabetes.