Validation of the Global Limb Anatomic Staging System in first-time lower extremity revascularization
| Autor: | Allen D. Hamdan, Vaishnavi Rao, Patric Liang, Emily St John, Mark C. Wyers, Daniel Kong, Jeremy D. Darling, Christina L. Marcaccio, Marc L. Schermerhorn |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Time Factors medicine.medical_treatment Ischemia 030204 cardiovascular system & hematology Revascularization Risk Assessment Severity of Illness Index Amputation Surgical Lesion 03 medical and health sciences Peripheral Arterial Disease 0302 clinical medicine Restenosis Predictive Value of Tests Risk Factors medicine Humans 030212 general & internal medicine Aged Retrospective Studies Aged 80 and over Proportional hazards model business.industry Hazard ratio Endovascular Procedures Angiography Reproducibility of Results Middle Aged medicine.disease Limb Salvage Confidence interval Surgery Treatment Outcome Amputation Lower Extremity Chronic Disease Female medicine.symptom Cardiology and Cardiovascular Medicine business Vascular Surgical Procedures |
| Zdroj: | Journal of vascular surgery. 73(5) |
| ISSN: | 1097-6809 |
| Popis: | The Global Limb Anatomic Staging System (GLASS) was developed as a new anatomic classification scheme to grade the severity of chronic limb threatening ischemia. We evaluated the ability of this anatomic grading system to determine major adverse limb events after lower extremity revascularization.We performed a single-institutional retrospective review of 1060 consecutive patients who had undergone 1180 first-time open or endovascular revascularization procedures for chronic limb threatening ischemia from 2005 to 2014. Using the review of angiographic images, the limbs were classified as GLASS stage 1, 2, or 3. The primary composite outcome was reintervention, major amputation (below- or above-the-knee amputation), and/or restenosis (3.5× step-up by duplex criteria) events (RAS). The secondary outcomes included all-cause mortality, failure to cross the lesion by endovascular methods, and a comparison between bypass vs endovascular intervention. Kaplan-Meier estimates were used to determine the event rates at 1 and 5 years, and Cox regression analysis was used to adjust for baseline differences among the GLASS stages.Of all patients undergoing first-time revascularization, imaging studies were available for 1180 procedures (91%) for GLASS grading. Of these procedures, 552 were open bypass (47%) and 628 were endovascular intervention (53%). Compared with GLASS stage 1 disease (n = 267, 23%), stage 2 (n = 367; 31%) and stage 3 (n = 546; 42%) disease were associated with a greater risk of RAS at 1 year (stage 1, 33% vs stage 2, 48% vs stage 3, 53%) and 5 years (stage 1, 45% [reference]; stage 2, 65%; hazard ratio [HR], 1.7; 95% confidence interval [CI], 1.3-2.2; P .001; stage 3, 69%; HR, 2.3; 95% CI, 1.7-2.9; P .001). These differences were mainly driven by reintervention and restenosis rather than by major amputation. The 5-year mortality was similar for stage 2 and 3 compared with stage 1 disease (stage 1, 40% [reference]; stage 2, 45%; HR, 1.1; 95% CI, 0.8-1.4; P = .69; stage 3, 49%; HR, 1.2; 95% CI, 1.0-1.6; P = .11). For all attempted endovascular interventions, failure to cross a target lesion increased with advancing GLASS stage (stage 1, 4.5% vs stage 2, 6.3% vs stage 3, 13.3%; P .01). Compared with open bypass (n = 552; 46.8%), endovascular intervention (n = 628; 53.3%) was associated with a higher rate of 5-year RAS for GLASS stage 1 (49% vs 34%; HR, 1.9; 95% CI, [1.1-3.5; P = .03), stage 2 (69% vs 52%; HR, 1.7; 95% CI, 1.2-2.5; P .01), and stage 3 (83% vs 61%; HR, 1.5; 95% CI, 1.2-2.0; P .01) disease.For patients undergoing first-time lower extremity revascularization, the GLASS can be used to predict for reintervention and restenosis. Bypass resulted in better long-term outcomes compared with endovascular intervention for all GLASS stages. |
| Databáze: | OpenAIRE |
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