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GLASS (Global Limb Anatomic Staging System): a critical appraisal
Roberto Ferraresi1, Alessandro Ucci2, Andrea Casini3
1Clinic of Diabetic Foot, San Carlo Clinic, Paderno Dugnano, Milan, Italy - ferraresi.md@gmail.com.
The Journal of Cardiovascular Surgery
|December 14, 2020
Summary
The Global Anatomic Staging System (GLASS) for chronic limb-threatening ischemia (CLTI) showed most patients had either simple or complex disease. This real-world data highlights the need to include infra-malleolar disease in the GLASS for better CLTI patient classification.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Interventions
Background:
- The Global Vascular Guidelines (GVGs) introduced the Global Anatomic Staging System (GLASS) to categorize intervention complexity into three stages.
- Chronic limb-threatening ischemia (CLTI) requires accurate staging for effective treatment planning and outcome prediction.
- Evaluating the real-world distribution of the GLASS is crucial for its clinical applicability.
Purpose of the Study:
- To retrospectively classify a large cohort of CLTI patients using the proposed Global Anatomic Staging System (GLASS).
- To assess the distribution and applicability of the GLASS in a real-world clinical setting.
- To identify potential areas for improvement within the GLASS framework.
Main Methods:
- Retrospective, single-center observational study of consecutive CLTI patients undergoing infra-inguinal endovascular revascularization (June 2014 - September 2019).
- Patients were classified using the GLASS for femoro-popliteal (FP) and infra-popliteal (IP) segments.
- FP and IP grades were combined to determine the final GLASS stage for each limb.
Main Results:
- 1995 CLTI patients underwent 2850 endovascular procedures, treating 6009 arterial lesions.
- FP segment grading: 45.3% grade 0, 16.6% grade 1, 5.6% grade 2, 7.4% grade 3, 25.1% grade 4.
- IP segment grading: 53.6% grade 0, 6.4% grade 1, 2.8% grade 2, 7.3% grade 3, 29.9% grade 4.
- Combined FP and IP grading resulted in GLASS stages: 32.3% stage 1, 13.2% stage 2, 51.6% stage 3.
- The distribution of GLASS stages was concentrated at the extremes (stages 1 and 3), with fewer intermediate (stage 2) cases.
Conclusions:
- The real-world distribution of the GLASS for femoro-popliteal and infra-popliteal segments showed a bimodal pattern, with scarce intermediate grades.
- A significant proportion of CLTI patients presented with severe infra-popliteal disease or absent pedal arch.
- The findings underscore the necessity of incorporating infra-malleolar disease assessment into the GLASS for comprehensive CLTI staging.
