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Published on: September 22, 2020
Evaluation of global limb anatomic staging system for patients with chronic limb-threatening ischemia treated with
Tony R Soares1, Gonçalo Cabral1, Tiago Costa1
1Department of Angiology and Vascular Surgery, Hospital Beatriz Ângelo, Loures, Portugal.
Insights
The Global Limb Anatomic Staging System (GLASS) stage did not predict outcomes for chronic limb-threatening ischemia (CLTI) patients undergoing distal bypass. Vein grafting provided excellent limb salvage and low recurrence rates for CLTI.
Area of Science:
- Vascular Surgery
- Clinical Outcomes Research
- Limb Salvage Surgery
Background:
- Chronic limb-threatening ischemia (CLTI) poses significant risks of amputation and mortality.
- Accurate staging systems are crucial for predicting outcomes in CLTI patients.
- The Global Limb Anatomic Staging System (GLASS) aims to stratify CLTI severity.
Purpose of the Study:
- To evaluate the relationship between the Global Limb Anatomic Staging System (GLASS) stage and clinical outcomes.
- To assess the effectiveness of distal bypass with vein grafting in patients with CLTI.
- To determine if GLASS staging influences patency and limb salvage rates.
Main Methods:
- Retrospective analysis of 190 CLTI patients undergoing 211 distal bypasses with vein grafting (2012-2019).
- Primary endpoint: freedom from CLTI (amputation-free survival, wound healing, no rest pain).
- Secondary endpoints: recurrence, amputation, survival, adverse limb events, and patency rates.
Main Results:
- GLASS stage did not correlate with patency or clinical outcomes.
- 80% of revascularized limbs were free from CLTI at 12 months.
- At 4 years: 25% recurrence, 83% free from major amputation, 64% limb-based patency.
Conclusions:
- GLASS stage is not a significant predictor of outcomes after distal bypass with vein grafting for CLTI.
- Distal open revascularization with vein grafts offers excellent CLTI freedom and low recurrence rates.
- This approach is effective for managing CLTI, regardless of anatomical complexity.
Objective:
We evaluated the relationship of the global limb anatomic staging system (GLASS) stage with the clinical outcomes for patients with chronic limb-threatening ischemia (CLTI) who had undergone distal bypass with vein grafting.
Methods:
We performed a single-center, retrospective analysis of patients with CLTI who had undergone distal bypass with vein grafting from January 2012 to December 2019. The primary end point was freedom from CLTI, including amputation-free survival, complete wound healing, and no ischemic rest pain. The secondary end points included a composite outcome of recurrence (patients who had achieved freedom from CLTI but had developed a new wound or ischemic rest pain), major limb amputation, amputation free-survival, overall survival, major adverse limb events, limb-based patency, and primary and secondary patency rates.
Results:
A total of 190 patients had undergone 211 distal bypasses with a median follow-up of 30 months. Of these patients, 80% had had diabetes or end-stage renal disease requiring dialysis. Most patients (63%) had experienced major or extensive tissue loss (WIfI [wound, ischemia, foot infection] wound class ≥2), and more than one half of these had had some degree of infection of the foot. A severe anatomic pattern (GLASS stage III) was predominant, with a prevalence of 78%. No significant differences were found between GLASS stage I and II and GLASS stage III groups for all the outcomes analyzed. Approximately 80% of the 211 revascularized limbs were free of CLTI at 12 months after treatment. At 4 years of follow-up, we observed that 25% of the patients had had CLTI recurrence, 83% were free from major amputation, and 61% were free from major adverse limb events. Limb-based patency, primary patency, and secondary patency were 79%, 80%, and 93% at 1 year and 64%, 65%, and 81% at 4 years, respectively.
Conclusions:
The GLASS stage was not related to patency or the clinical outcomes after distal bypass with vein grafting. Distal open revascularization resulted in excellent rates of freedom from CLTI with low rates of CLTI recurrence, two key time-integrated outcomes of clinical disease severity for patients with CLTI.
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