Arterial calcification is prevalent in peripheral artery disease (PAD), especially among patients with advanced age, diabetes, or renal disease. Peripheral arterial calcium score (PACS) is an emerging tool to quantify calcification in peripheral arteries and predict outcomes such as amputation and mortality. This systematic review evaluates PACS methodologies and its association with these adverse outcomes. In a comprehensive search of Embase, MEDLINE (PubMed), and PubMed Central (PMC) from January 1991 to January 2025, 1092 studies were retrieved, of which 17 met the inclusion criteria. Computed tomography and X-ray imaging were the main imaging modalities used to detect calcification through a variety of PACS. A higher PACS was linked to increased risk of amputation and/or mortality. PACS holds potential for predicting outcomes in PAD, particularly amputation and mortality. Standardization of PACS methods is needed to enhance its clinical utility and integration into practice.
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