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The Infrapopliteal Global Limb Anatomic Staging System Predicts Wound Healing and Pain Relief after Partial

Sohei Matsuura1, Takuya Hashimoto2, Masamitsu Suhara2

  • 1Department of Vascular Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan; Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

Annals of Vascular Surgery
|September 4, 2022
PubMed

Insights

Partial revascularization (PR) can salvage limbs in chronic limb-threatening ischemia (CLTI). Infrapopliteal grade and hypoalbuminemia are key predictors of successful wound healing after PR for CLTI.

Area of Science:

  • Vascular Surgery
  • Limb Salvage Procedures
  • Ischemia Management

Background:

  • Chronic limb-threatening ischemia (CLTI) often involves crural artery occlusion, making complete revascularization difficult.
  • Partial revascularization (PR) may offer symptom relief, but patient selection for successful outcomes remains unclear.
  • Identifying factors influencing PR success is crucial for limb salvage in CLTI patients.

Purpose of the Study:

  • To evaluate factors affecting outcomes after partial revascularization (PR) in patients with chronic limb-threatening ischemia (CLTI).
  • To identify predictors of successful limb salvage and wound healing following PR.
  • To assess the utility of wound, ischemia, and foot infection (WIfI) and Global Limb Anatomic Staging System (GLASS) classifications in predicting PR outcomes.

Main Methods:

  • Retrospective review of 103 patients undergoing first-attempt PR for CLTI between April 2012 and December 2020.
  • Patients were categorized into salvage (wound healing/pain relief) and nonsalvage (amputation/further intervention) groups.
  • Analysis of patient risk factors, limb severity (WIfI), and anatomical patterns (GLASS) to determine outcome predictors.

Main Results:

  • Infrapopliteal grade (GLASS) and hypoalbuminemia were significant predictors of PR success in multivariate analysis.
  • While not statistically significant, hypoalbuminemia was more prevalent in the nonsalvage group (P=0.068).
  • Wound grade showed a correlation with healing, suggesting reduced wound severity predicts better outcomes.

Conclusions:

  • The study validates the usefulness of WIfI and GLASS classifications in predicting wound healing after PR for CLTI.
  • Infrapopliteal anatomical complexity and nutritional status (hypoalbuminemia) are critical factors for successful PR outcomes.
  • These classifications aid in patient selection and management strategies for limb salvage in CLTI.
Abstract

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