Martínez-Rico Carlos, Martí-Mestre Xavier, Martínez-Del Carmen Dorelly, Iborra-Ortega Elena
Department of Endovascular and Vascular Surgery, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain; IDIBELL, Institut Investigació Biomèdica de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain.
Department of Endovascular and Vascular Surgery, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain; IDIBELL, Institut Investigació Biomèdica de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain.
J Vasc Surg. 2025 Mar;81(3):704-709. doi: 10.1016/j.jvs.2024.10.076. Epub 2024 Nov 9.
Obtaining a prognostic and predictive classification based on the risk of amputation is crucial in ischemic pathology of the lower limbs. Accurate anatomical characterization of arterial lesions is essential for optimal clinical decision-making. The Global Limb Anatomic Staging System (GLASS) provides a comprehensive anatomy assessment of the femoropopliteal and infrapopliteal arterial system. GLASS introduces concepts such as the target arterial path and estimated limb-based patency, crucial for determining the best arterial route to restore blood flow.
A prospective study conducted from May to December 2022 involved 66 patients undergoing revascularization surgery for critical limb-threatening ischemia. Preoperative arterial mapping using duplex ultrasonography was the sole imaging modality. The target arterial path was defined in each patient, and GLASS staging was determined. Intraoperative arteriography was used on the day of surgery for comparison. Agreement between preoperative arterial mapping and intraoperative arteriography was assessed using Cohen's kappa coefficient, and diagnostic metrics were compared using receiver operating characteristic curves.
Doppler ultrasound demonstrated a sensitivity of 98%, specificity and positive predictive value of 100%, and negative predictive value of 94.7% in the femoropopliteal sector, with a Kappa coefficient of 0.98. For the infrapopliteal sector, sensitivity was 95%, specificity 96.5%, positive predictive value 97.3%, and negative predictive value 93.3%, with a Kappa coefficient of 0.89. Combining both sectors, the overall GLASS stage showed a 93.9% concordance with a Kappa coefficient of 0.91. Receiver operating characteristic curves revealed no significant differences between ultrasound and arteriography in terms of staging.
This study demonstrates that Doppler ultrasound can serve as the exclusive imaging modality for determining the preoperative GLASS stage.
基于截肢风险获得预后和预测分类在下肢缺血性病变中至关重要。动脉病变的准确解剖特征对于优化临床决策至关重要。全球肢体解剖分期系统（GLASS）对股腘动脉和腘下动脉系统进行了全面的解剖评估。GLASS引入了目标动脉路径和基于肢体的估计通畅率等概念，这对于确定恢复血流的最佳动脉路径至关重要。
2022年5月至12月进行的一项前瞻性研究纳入了66例因严重肢体威胁性缺血而接受血管重建手术的患者。术前使用双功超声进行动脉造影是唯一的成像方式。确定每位患者的目标动脉路径，并确定GLASS分期。手术当天使用术中动脉造影进行比较。使用Cohen's kappa系数评估术前动脉造影与术中动脉造影之间的一致性，并使用受试者工作特征曲线比较诊断指标。
在股腘动脉区域，多普勒超声显示敏感性为98%，特异性和阳性预测值为100%，阴性预测值为94.7%，Kappa系数为0.98。在腘下动脉区域，敏感性为95%，特异性为96.5%，阳性预测值为97.3%，阴性预测值为93.3%，Kappa系数为0.89。综合两个区域，总体GLASS分期显示一致性为93.9%，Kappa系数为0.91。受试者工作特征曲线显示超声和动脉造影在分期方面无显著差异。
本研究表明，多普勒超声可作为确定术前GLASS分期的唯一成像方式。
