Objective
This study aimed to analyse the influence of the Global Anatomic Staging System (GLASS)
and inframalleolar (IM) disease on the treatment outcomes of patients with chronic
limb threatening ischaemia (CLTI) who undergo endovascular treatment (EVT)
Methods
Data of patients who underwent infrainguinal endovascular therapy (EVT) for CLTI between
2015 and 2019 at two centres were analysed retrospectively. The endpoints were major
amputation, major adverse limb events (MALE), and wound healing.
Results
Overall, 276 patients and 340 limbs were analysed. The number of revascularisations
for an infrapopliteal lesion was 48 (70.6%), 63 (63.0%), and 142 (82.6%) in the GLASS
I, GLASS II, and GLASS III stages, respectively (p < .001). There was no statistically significant difference in limb salvage among
the GLASS stages (p = .78). The limb salvage rates at one year were 94.6%, 88.0%, and 70.0% in the IM
P0 P1, and P2 groups, respectively (p < .001). Multivariable analysis showed that Wound, Ischemia, and foot Infection (WIfI)
stage, and IM grade were risk factors for major amputation. The freedom from MALE
rates at two years were 60.5%, 45.3%, and 41.1% in the GLASS I, II, and III stages,
respectively (p = .003) and 64.1%, 43.5%, and 18.4% in the IM P0, P1, and P2 groups, respectively
(p < .001). Multivariable analysis demonstrated that WIfI stage, GLASS stage, IM grade,
and infrapopliteal revascularisation were risk factors for MALE. There was no significant
difference in wound healing among GLASS I – III (p = .75). The wound healing rates at 365 days were 78.6%, 68.6%, and 42.0% in the IM
P0, P1, and P2 groups, respectively (p = .065). Multivariable analysis showed that WIfI stage and IM P2 were risk factors
for incomplete wound healing.
Conclusion
GLASS IM was associated with major amputation, MALE, and wound healing, while GLASS
stage was associated with only MALE.
Keywords
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Article info
Publication history
Published online: December 02, 2022
Accepted:
November 29,
2022
Received:
May 23,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.
