Yamada Takehiro, Shibahara Taro, Nagase Masaru, Ono Daiju, Tanabe Gen, Suzuki Keita, Yamaura Makoto, Ido Takahisa, Nakashima Takashi, Takahashi Shigekiyo, Aoyama Takuma
Division of Cardiology, Cardiovascular Center, Kizawa Memorial Hospital, 590 Shimokobi, Kobi, Gifu, Minokamo, 5058503, Japan.
Division of Molecular Pathology, Shinshu University of Medicine, Matsumoto, Japan.
Heart Vessels. 2022 Mar;37(3):496-504. doi: 10.1007/s00380-021-01937-5. Epub 2021 Sep 7.
This study aimed to validate the correlation between the Global Limb Anatomical Staging System (GLASS) and limb-based patency (LBP) and angiosome-based target arterial path (TAP) and to detect the predictors of LBP loss. After the publication of the Global Vascular Guidelines in 2019, the evaluation of GLASS and identification of TAP have been recommended. However, there are few reports regarding GLASS. Eighty-three patients with chronic limb-threatening ischemia (CLTI) and tissue loss from 2016 to 2020 were evaluated. The correlation between GLASS and LBP and successful revascularization of angiosome-based TAP was analyzed. We also investigated the predictors of LBP loss. The number of patients in each GLASS stage was as follows: GLASS I, 6 patients; GLASS II, 15 patients; GLASS III, 62 patients. At 6 months, the Kaplan-Meier estimate of LBP was 66.7% in GLASS I, 41.6% in GLASS II, and 16.4% in GLASS III, respectively (p = 0.034). The rate of successful revascularization of angiosome-based TAP was 100% in GLASS I, 86.7% in GLASS II, and 46.8% in GLASS III, respectively (p = 0.002). Multivariate analysis showed that the Wound, Ischemia, and foot Infection (WIfI) stage [hazard ratio (HR) 1.58; 95% confidence interval (CI) 1.07-2.33; p = 0.021] and GLASS infrapopliteal (IP) grade (HR 1.96; 95% CI 1.31-2.95; p = 0.001) were the independent predictors of LBP loss. The GLASS stage was significantly correlated with successful revascularization of angiosome-based TAP and mid-term LBP. The WIfI stage and GLASS IP grade were the independent predictors of loss of LBP.
本研究旨在验证全球肢体解剖分期系统（GLASS）与基于肢体的通畅率（LBP）和基于血管体的目标动脉路径（TAP）之间的相关性，并检测LBP丧失的预测因素。在2019年全球血管指南发布后，推荐对GLASS进行评估并确定TAP。然而，关于GLASS的报道很少。对2016年至2020年期间83例慢性肢体威胁性缺血（CLTI）和组织缺损患者进行了评估。分析了GLASS与LBP以及基于血管体的TAP成功血运重建之间的相关性。我们还研究了LBP丧失的预测因素。各GLASS分期的患者数量如下：GLASS I期，6例患者；GLASS II期，15例患者；GLASS III期，62例患者。6个月时，GLASS I期、II期和III期的LBP的Kaplan-Meier估计值分别为66.7%、41.6%和16.4%（p = 0.034）。基于血管体的TAP成功血运重建率在GLASS I期为100%，GLASS II期为86.7%，GLASS III期为46.8%（p = 0.002）。多变量分析显示，伤口、缺血和足部感染（WIfI）分期[风险比（HR）1.58；95%置信区间（CI）1.07 - 2.33；p = 0.021]和GLASS腘动脉以下（IP）分级（HR 1.96；95% CI 1.31 - 2.95；p = 0.001）是LBP丧失的独立预测因素。GLASS分期与基于血管体的TAP成功血运重建和中期LBP显著相关。WIfI分期和GLASS IP分级是LBP丧失的独立预测因素。
