Zhang Bihui, Yao Ziping, Niu Guochen, Yan Ziguang, Zou Yinghua, Tong Xiaoqiang, Yu Xiaoxi, Ma Bo, Liu Bao, Ye Zhidong, Yang Min
Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China.
Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China.
Quant Imaging Med Surg. 2023 Mar 1;13(3):1350-1359. doi: 10.21037/qims-22-715. Epub 2022 Nov 30.
The Global Limb Anatomic Staging System (GLASS) was proposed to assess the procedural complexity and technical failure rate and stratify the anatomic pattern of chronic limb-threatening ischemia (CLTI). However, more evidence is needed to validate the GLASS in staging outcomes after endovascular therapy in patients with CLTI treated with drug-coated balloons (DCBs). This study aims to evaluate the role of the GLASS in predicting outcomes of CLTI patients treated with DCBs.
This multicenter, retrospective cohort study enrolled patients with CLTI treated with DCBs from July 2016 to June 2019. GLASS stages were assigned for every limb. The limb-based patency (LBP) rate, clinically driven target lesion revascularization (CD-TLR) rate, clinical improvement, and safety endpoints were analyzed and compared across the GLASS stages over 12 months of follow-up. Risk factors for the loss of LBP were identified using Cox regression analysis.
A total of 90 limbs were enrolled, with 55 (61.1%) having isolated femoropopliteal lesions and 35 (38.9%) having femoropopliteal and infrapopliteal lesions. Of the limbs, 17 (18.9%), 12 (13.3%), and 61 (67.8%) were assigned to GLASS stages I, II, and III, respectively. The Kaplan-Meier estimate of the 12-month LBP was 65.4%, and no difference was found among the different stages (stage I 81.1%; stage II 85.2%; stage III 54.4%; P=0.080). The LBP was lower in stage III than in stages I and II combined (stage I and II 83.5%; stage III 54.4%; P=0.027). Similar results were found for the freedom from CD-TLR rates among the different stages. The ankle-brachial index values improved from 0.42±0.29 to 0.78±0.35 at follow-up (P<0.001). The rates of mortality, any amputation, and major amputation were similar among the groups. GLASS stage III and coronary heart disease were identified as independent risk factors for the loss of LBP at 12 months.
The 1-year LBP and freedom from CD-TLR rates were lower in GLASS stage III than in stages I and II. The GLASS classification could predict the outcomes of CLTI patients with femoropopliteal lesions treated with DCB.
全球肢体解剖分期系统（GLASS）旨在评估手术复杂性和技术失败率，并对慢性肢体威胁性缺血（CLTI）的解剖模式进行分层。然而，需要更多证据来验证GLASS在接受药物涂层球囊（DCB）治疗的CLTI患者血管内治疗后的分期结果中的作用。本研究旨在评估GLASS在预测接受DCB治疗的CLTI患者结局中的作用。
这项多中心回顾性队列研究纳入了2016年7月至2019年6月接受DCB治疗的CLTI患者。为每个肢体指定GLASS分期。分析并比较了12个月随访期间各GLASS分期的基于肢体的通畅率（LBP）、临床驱动的靶病变血运重建（CD-TLR）率、临床改善情况和安全性终点。使用Cox回归分析确定LBP丧失的危险因素。
共纳入90条肢体，其中55条（61.1%）为单纯股腘动脉病变，35条（38.9%）为股腘动脉和腘以下动脉病变。在这些肢体中，17条（18.9%）、12条（13.3%）和61条（67.8%）分别被分配到GLASS I期、II期和III期。12个月LBP的Kaplan-Meier估计值为65.4%，不同分期之间未发现差异（I期81.1%；II期85.2%；III期54.4%；P=0.080）。III期的LBP低于I期和II期之和（I期和II期83.5%；III期54.4%；P=0.027）。不同分期的无CD-TLR率也得到了类似结果。随访时踝臂指数值从0.42±0.29提高到0.78±0.35（P<0.001）。各组之间的死亡率、任何截肢率和大截肢率相似。GLASS III期和冠心病被确定为12个月时LBP丧失的独立危险因素。
GLASS III期的1年LBP和无CD-TLR率低于I期和II期。GLASS分类可以预测接受DCB治疗的股腘动脉病变CLTI患者的结局。
