Department of Angiology and Vascular Surgery, Hospital Beatriz Ângelo, Loures, Portugal.
Department of Angiology and Vascular Surgery, Hospital Beatriz Ângelo, Loures, Portugal.
J Vasc Surg. 2022 Nov;76(5):1347-1353.e2. doi: 10.1016/j.jvs.2022.06.008. Epub 2022 Jun 21.
We evaluated the relationship of the global limb anatomic staging system (GLASS) stage with the clinical outcomes for patients with chronic limb-threatening ischemia (CLTI) who had undergone distal bypass with vein grafting.
We performed a single-center, retrospective analysis of patients with CLTI who had undergone distal bypass with vein grafting from January 2012 to December 2019. The primary end point was freedom from CLTI, including amputation-free survival, complete wound healing, and no ischemic rest pain. The secondary end points included a composite outcome of recurrence (patients who had achieved freedom from CLTI but had developed a new wound or ischemic rest pain), major limb amputation, amputation free-survival, overall survival, major adverse limb events, limb-based patency, and primary and secondary patency rates.
A total of 190 patients had undergone 211 distal bypasses with a median follow-up of 30 months. Of these patients, 80% had had diabetes or end-stage renal disease requiring dialysis. Most patients (63%) had experienced major or extensive tissue loss (WIfI [wound, ischemia, foot infection] wound class ≥2), and more than one half of these had had some degree of infection of the foot. A severe anatomic pattern (GLASS stage III) was predominant, with a prevalence of 78%. No significant differences were found between GLASS stage I and II and GLASS stage III groups for all the outcomes analyzed. Approximately 80% of the 211 revascularized limbs were free of CLTI at 12 months after treatment. At 4 years of follow-up, we observed that 25% of the patients had had CLTI recurrence, 83% were free from major amputation, and 61% were free from major adverse limb events. Limb-based patency, primary patency, and secondary patency were 79%, 80%, and 93% at 1 year and 64%, 65%, and 81% at 4 years, respectively.
The GLASS stage was not related to patency or the clinical outcomes after distal bypass with vein grafting. Distal open revascularization resulted in excellent rates of freedom from CLTI with low rates of CLTI recurrence, two key time-integrated outcomes of clinical disease severity for patients with CLTI.
我们评估了全球肢体解剖分期系统（GLASS）分期与接受静脉移植物远端旁路手术的慢性肢体威胁性缺血（CLTI）患者临床结局的关系。
我们对 2012 年 1 月至 2019 年 12 月期间接受静脉移植物远端旁路手术的 CLTI 患者进行了单中心回顾性分析。主要终点是无 CLTI 的生存率，包括免于截肢的生存率、完全伤口愈合率和无缺血性静息痛率。次要终点包括复发的复合终点（达到无 CLTI 但出现新伤口或缺血性静息痛的患者）、主要肢体截肢、免于截肢的生存率、总生存率、主要肢体不良事件、肢体通畅率以及主、次通畅率。
共有 190 例患者接受了 211 次远端旁路手术，中位随访时间为 30 个月。这些患者中 80%有糖尿病或需要透析的终末期肾病。大多数患者（63%）有严重或广泛的组织缺失（WIfI[伤口、缺血、足部感染]伤口分级≥2），其中一半以上的患者足部有某种程度的感染。严重的解剖模式（GLASS 分期 III）占主导地位，患病率为 78%。对于分析的所有结果，GLASS 分期 I 和 II 组与 GLASS 分期 III 组之间没有显著差异。治疗后 12 个月，211 条再血管化肢体中约有 80%无 CLTI。在 4 年的随访中，我们观察到 25%的患者出现 CLTI 复发，83%免于主要截肢，61%免于主要肢体不良事件。1 年时的肢体通畅率、主通畅率和次通畅率分别为 79%、80%和 93%，4 年时分别为 64%、65%和 81%。
GLASS 分期与静脉旁路术后的通畅率或临床结局无关。远端开放血运重建可使 CLTI 免于复发的比例非常高，这是 CLTI 患者临床疾病严重程度的两个关键时间综合结局。
