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Published on: September 22, 2020
Validation of the global limb anatomical staging system in Vietnamese patients treated for chronic limb-threatening
Tran Minh Bao Luan1,2, Nguyen Huu Tuong3, Tran Ngoc Dang4
1Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, 700000, Viet Nam.
Insights
The Global Anatomic Staging System (GLASS) effectively predicts outcomes for chronic limb-threatening ischemia (CLTI) patients undergoing endovascular intervention. Higher GLASS stages correlate with lower technical success and increased amputation and mortality rates.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Peripheral Artery Disease Research
Background:
- Chronic limb-threatening ischemia (CLTI) is a severe form of peripheral artery disease (PAD) linked to high amputation, cardiovascular events, and mortality rates.
- The Global Vascular Guideline (GVG) introduced the Global Anatomic Staging System (GLASS) to classify arterial lesion complexity.
- Further research is needed to validate GLASS in predicting endovascular intervention outcomes for CLTI patients.
Purpose of the Study:
- To describe clinical characteristics, arterial lesions, and endovascular interventions in Vietnamese CLTI patients stratified by GLASS.
- To evaluate technical success, mortality, and limb preservation rates based on GLASS grades.
Main Methods:
- Retrospective analysis of 82 CLTI patients undergoing infrainguinal endovascular intervention from June 2020 to June 2022.
- Patients were categorized into three groups based on GLASS (I, II, III).
- Outcomes including technical success, limb-based patency, amputation, and mortality rates were assessed at 6 and 12 months post-intervention.
Main Results:
- Technical success rates decreased with increasing GLASS complexity (90% for I, 86.11% for II, 56.25% for III).
- Limb-based patency at 12 months was significantly lower in GLASS III (22.22%) compared to GLASS I (88.89%) and II (67.74%).
- Amputation rates at 12 months were 13.3% (I), 22.2% (II), and 50% (III); mortality rates were 0% (I), 8.33% (II), and 25% (III).
Conclusions:
- Higher GLASS stages in CLTI patients are associated with reduced technical success rates following endovascular intervention.
- CLTI patients with higher GLASS stages exhibit significantly increased rates of limb amputation and mortality.
Background:
Chronic limb-threatening ischemia (CLTI) is the most severe clinical form of peripheral artery disease (PAD), accounting for approximately 11%, and is strongly associated with the incidence of amputation, cardiovascular events, and mortality. The Global Vascular Guideline (GVG) proposed a new Global Anatomic Staging System (GLASS) for evaluating the anatomic complexity of arterial lesions. However, more research is required to evaluate outcomes after endovascular intervention in CLTI patients using the GLASS.
Objective:
Our study aimed to describe clinical characteristics, arterial lesions, and endovascular interventions according to three grades of GLASS in the Vietnamese population. We evaluated the technical success, mortality rate, and probability to preserve the limb according to the GLASS.
Methods:
All patients were diagnosed with CLTI and underwent infrainguinal endovascular intervention at the Department of Thoracic and Vascular Surgery, University Medical Center, Ho Chi Minh City from June 2020 to June 2022. All patients were evaluated before intervention and follow-up at 6 and 12 months after intervention. Patients were divided into three groups according to the GLASS, thereby comparing the technical success, mortality, and amputation rates. This retrospective study describes a series of cases.
Results:
The study sample evaluated 82 lower limbs of 82 patients, in which GLASS class I, II, and III lesions accounted for 36.6%, 43.9%, and 19.5% of the patients, respectively. The rates of technical success in the groups gradually decreased according to the complexity of the lesions (90%, 86.11%, and 56.25% for GLASS I, II, and III, respectively; p = 0.012). Notably, limb-based patency (LBP) at 12 months was significantly lower in the GLASS III group than in the GLASS I and II groups (22.22% vs 88.89% and 67.74%, respectively; p = 0.001). The amputation rates at 12 months in GLASS groups I, II, and III were 13.3%, 22.2%, and 50%, respectively (p = 0.021), while the mortality rates at 12 months were 0%, 8.33%, and 25%, respectively (p = 0.015).
Conclusion:
In patients with CLTI of higher GLASS stages, the rates of technical success were lower and the amputation and mortality rates were higher.
