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Published on: September 22, 2020
Validation of the GLASS Staging Systems in Patients With Chronic Limb-Threatening Ischemia Undergoing De Novo
Koichi Morisaki1, Yutaka Matsubara1, Shinichiro Yoshino1
1Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Insights
The Global Limb Anatomic Staging System (GLASS) did not predict limb salvage or wound healing in chronic limb-threatening ischemia (CLTI) patients undergoing revascularization. However, GLASS stage was a significant prognostic factor for overall survival (OS).
Area of Science:
- Vascular Surgery
- Clinical Outcomes Research
- Arterial Disease Staging
Background:
- Chronic limb-threatening ischemia (CLTI) poses a significant challenge in vascular surgery.
- Accurate anatomic staging is crucial for guiding treatment decisions and predicting outcomes.
- The Global Limb Anatomic Staging System (GLASS) was developed to assess arterial disease complexity in CLTI.
Purpose of the Study:
- To evaluate the relationship between the Global Limb Anatomic Staging System (GLASS) stage and treatment outcomes.
- To determine if GLASS stage impacts limb salvage, wound healing, and overall survival (OS) after infrainguinal revascularization in CLTI patients.
Main Methods:
- Retrospective analysis of 153 CLTI patients undergoing infrainguinal revascularization (2010-2018).
- Assessment of limb salvage, wound healing, and OS based on GLASS and WIfI staging.
- Multivariate analysis to identify risk factors for adverse outcomes.
Main Results:
- Wound, Ischemia, and Foot Infection (WIfI) stage and inframalleolar (IM) disease were significant predictors of major amputation and impaired wound healing.
- GLASS stage did not correlate with limb salvage or wound healing.
- GLASS stage, age, and geriatric nutritional risk index were identified as risk factors for 2-year OS.
Conclusions:
- WIfI stage and IM disease are key predictors of limb salvage and wound healing in CLTI patients post-revascularization.
- GLASS stage, while not affecting limb salvage or wound healing, serves as a prognostic indicator for overall survival.
- GLASS staging may aid in treatment selection by predicting patient prognosis.
Objectives:
The Global Limb Anatomic Staging System (GLASS) was proposed for evaluating the anatomic complexity of arterial disease in patients with chronic limb-threatening ischemia (CLTI). We aimed to examine the relationship between GLASS stage and treatment outcomes after infrainguinal revascularization in patients with CLTI.
Methods:
We retrospectively analyzed data of patients undergoing infrainguinal revascularization for CLTI between 2010 and 2018 to examine whether GLASS stage affects the limb salvage, wound healing, and overall survival (OS).
Results:
Throughout the study period, 153 CLTI patients and 190 limbs with Fontaine classification III and IV were analyzed for major amputation and OS, and 125 patients and 157 limbs of Fontaine classification IV were analyzed for wound healing. The number of patients with WIfI stage 1, 2, 3, and 4 was 14 (7.4%), 44 (23.2%), 65 (34.2%), and 67 (53.3%), respectively. The number of patients with GLASS stage I, II, and III was 23 (12.1%), 48 (25.3%), and 119 (62.6%), respectively. Among the 190 limbs, the number subject to bypass surgery, endovascular therapy, and hybrid therapy was 132 (69.5%), 39 (20.5%), and 19 (10.0%), respectively. A multivariate analysis showed that only WIfI stage and inframalleolar (IM) disease were risk factors for major amputation and impaired wound healing. There was no relationship between GLASS stage and limb salvage or wound healing. A multivariate analysis revealed that age, geriatric nutritional risk index and GLASS stage were risk factors for 2-year OS (P < 0.01). Patients with all risk factors had a poor prognosis (35.3% at 2 years).
Conclusion:
WIfI stage and IM disease predicted limb salvage and wound healing after infrainguinal revascularization in patients with CLTI. Although GLASS stage did not affect limb salvage or wound healing, it was a prognostic factor for poor OS. The GLASS staging could be useful for deciding between bypass surgery and endovascular therapy in prediction of prognosis.
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