The relationship between the Global Limb Anatomic Staging System (GLASS) and midterm outcomes of retrograde tibiopedal access after failure of antegrade recanalization for chronic limb threatening ischemia.

Faculty of Medicine

Assiut University

The relationship between the Global Limb Anatomic Staging System (GLASS) and midterm outcomes of retrograde tibiopedal access after failure of antegrade recanalization for chronic limb threatening ischemia.

Research Authors
Haitham Ali, Ahmed Elbadawy, Mostafa Abdelmonem, Mahmoud Saleh.
Research Date
Research Department
Department of vascular surgery
Research File
ej.pdf
Research Journal
European journal of vascular and endovascular surgery
Research Member
Mostafa Mohamed Elmohrezy Abdel-Moniem
Research Publisher
elsevier
Research Vol
preproof
Research Website
https://www.sciencedirect.com/science/article/abs/pii/S1078588422002362
Research Year
2022
Research Abstract

Objective

To examine the relationship between the Global Limb Anatomic Staging System (GLASS) and midterm limb- and survival-related outcomes of retrograde tibiopedal access, after failed recanalization of infrainguinal chronic total occlusions (CTOs) using the antegrade approach, in patients with chronic limb threatening ischemia (CLTI).

Methods

This prospective, observational study was conducted between January 2017 and April 2019, and included 213 patients (29 GLASS I, 53 GLASS II, and 131 GLASS III lesions) with infrainguinal CTO in whom a percutaneous tibiopedal access was attempted as a consequence of failed recanalization using an antegrade approach. Multivariable Cox proportional hazard regression was performed to assess possible predictors of midterm clinical outcomes. Kaplan-Meier survival curves were used to estimate limb based patency (LBP), limb salvage, amputation free survival (AFS), and overall survival.

Results

The study reported access, crossing, and treatment success of 92.5%, 89.2%, and 89.2% of all tibiopedal access attempts, respectively. In comparison to GLASS I, GLASS stage III was associated with significantly worse midterm LBP (p= .005), overall survival (p= .037), limb salvage (p= .021), and AFS (p <.001).

Conclusion

Retrograde tibiopedal access for recanalization of infrainguinal CTOs in patients with CLTI is associated with high access, crossing, and treatment success, and low complication rates. The study suggests that GLASS stage may be a useful predictor of midterm limb- and survival-related outcomes of this approach. In comparison to GLASS I, GLASS III anatomy is associated with a significantly worse LBP, limb salvage, AFS, and overall survival.