机构：[1]Department of Radiology, Tongji Medical College, Liyuan Hospital, Huazhong University of Science and Technology, Wuhan, China.[2]Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Institute, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China.[3]Department of Clinical Laboratory, Tongji Medical College, Liyuan Hospital, Huazhong University of Science and Technology, Wuhan, China.[4]Department of Wound Repair and Vascular Surgery, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.[5]Department of Burns, Tongren Hospital of Wuhan University, Wuhan, China - 1993ly0538@hust.edu.cn.[6]Wuhan Third Hospital, Wuhan, China.
Chronic limb-threatening ischemia (CLTI) affects millions of people and causes health care burden around the globe. Global Limb Anatomic Staging System (GLASS) was proposed as a new anatomic system for integrating the complexity of threatened limb.We retrospectively classified computed tomography angiography images of threatened limbs into GLASS stages between January 2018 and April 2020. Comorbidities, limb treatments , and outcomes including amputation-free survival (AFS), reintervention and mortality were compared and the likelihood of benefit from revascularization was estimated according to GLASS. Kaplan-Meier estimate was used to determine the rates of endpoint events at 1 year. Multivariate analysis was performed to identify predictors of those outcomes.In our study, 285 threatened limbs in 263 patients were stratified including GLASS stage I disease (n=53, 19%), stage II (n=129; 45%) and stage III (n=103; 36%) disease. The percentage of limbs undergoing endovascular revascularization and minor amputation increased significantly with increasing GLASS stage. On Kaplan-Meier analysis, increasing GLASS stage was associated with 1-year reduced AFS (stage I: 96.1%, stage II: 94.1%, stage III: 83.9%; log rank P=0.016). The percentage of 1-year reintervention rate in infrapopliteal GLASS grade 3-4 (15%) was significantly higher than the percentage of reintervention in infrapopliteal GLASS grade 0-2 (5%) (Log rank P=0.002). Infrapopliteal GLASS grade 3 and 4 was the independent predictor of reduced AFS and reintervention requirement.GLASS stage correlated with intensity of limb treatment and with clinical outcomes at 1 year. Infrapopliteal GLASS grade 3 and 4 independently predicted the reduced amputation-free survival.
