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Published on: September 22, 2020
Primary Limb-Based Patency for Chronic Limb-Threatening Ischemia Treated with Endovascular Therapy Based on the
Minyong Peng1, Chao Li2, Chengli Nie3
1Chinese Institutes for Medical Research, Beijing, Capital Medical University, Beijing, China.
Insights
The Global Limb Anatomic Staging System (GLASS) correlates with limb-based patency (LBP) after endovascular therapy for chronic limb-threatening ischemia (CLTI). Higher GLASS stages indicate poorer LBP outcomes, suggesting its use as a prognostic tool.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Medical Imaging
Background:
- Chronic limb-threatening ischemia (CLTI) poses a significant risk of limb loss.
- Endovascular therapy (EVT) is a common treatment for CLTI.
- Predictive tools are needed to assess outcomes after EVT for CLTI.
Purpose of the Study:
- To validate the Global Limb Anatomic Staging System (GLASS) against primary limb-based patency (LBP) in CLTI patients.
- To identify risk factors contributing to LBP loss following EVT.
- To assess the prognostic value of GLASS stages in CLTI patients undergoing EVT.
Main Methods:
- Retrospective analysis of 236 limbs from 231 CLTI patients treated with EVT (2018-2022).
- Lesions categorized into GLASS Stages I, II, and III.
- Primary LBP rates analyzed across GLASS stages; Cox regression used for risk factor identification.
Main Results:
- 1-year LBP rates decreased significantly with higher GLASS stages (Stage I: 78.8%, Stage II: 69.5%, Stage III: 41.6%; P < .001).
- Long-term LBP rates also showed a significant decline across stages (Stage I: 54.2%, Stage II: 38.6%, Stage III: 10.5%; P < .001).
- GLASS stages (especially III vs I/II), diabetes, smoking, and sex were independent predictors of LBP loss.
Conclusions:
- GLASS Stage III is associated with significantly lower LBP rates in CLTI patients post-EVT.
- The GLASS staging system demonstrates potential as a prognostic indicator for CLTI patients undergoing EVT.
- GLASS staging can aid in risk stratification and treatment planning for CLTI.
Purpose:
To validate the correlation between the Global Limb Anatomic Staging System (GLASS) and primary limb-based patency (LBP) and to identify the risk factors associated with LBP loss.
Materials And Methods:
A single-center retrospective analysis was performed on patients with chronic limb-threatening ischemia (CLTI) who underwent endovascular therapy (EVT) between January 2018 and May 2022. All lesions were categorized into 3 groups (GLASS Stages I, II, and III). The primary LBP rates were analyzed and compared across the GLASS stages. The risk factors for the loss of primary LBP were identified using Cox regression analysis.
Results:
In total, 236 limbs from 231 patients were included, with 52 (22%) limbs stratified as GLASS Stage I, 59 (25%) limbs as GLASS Stage II, and 125 (53%) limbs as GLASS Stage III. The 1-year LBP rates for limbs classified as GLASS Stages I, II, and III were 78.8%, 69.5%, and 41.6%, respectively (P < .001). The long-term LBP rate was 54.2% in GLASS Stage I, 38.6% in GLASS Stage II, and 10.5% in GLASS Stage III (P < .001). Multivariate analysis revealed that GLASS stages (GLASS Stage Ⅰ vs Ⅲ, hazard ratio [HR], 0.36; 95% CI, 0.18-0.72; P = .004; GLASS Stage Ⅱ vs Ⅲ, HR, 0.47; 95% CI, 0.25-0.86; P = .02), diabetes, smoking, and sex were independently associated with LBP.
Conclusions:
GLASS Stage III was associated with lower LBP rates in patients with CLTI who underwent EVT. The GLASS stages may serve as prognostic indicators for patients with CLTI after intervention.
