Primary Limb-Based Patency for Chronic Limb Threatening Ischemia Treated with Endovascular Therapy Based on the Global Limb Anatomic Staging System.

PURPOSE: This study aimed to validate the correlation between the Global Limb Anatomic Staging System (GLASS) and primary limb-based patency (LBP) and to identify the risk factors associated with LBP loss.

MATERIALS AND METHODS: A single-center retrospective analysis was performed on patients with chronic limb-threatening ischemia (CLTI) who underwent endovascular therapy (EVT) between January 2018 and May 2022. All lesions were categorized into three groups (GLASS I, II, and III). The primary LBP rates were analyzed and compared across the GLASS stages. The risk factors for the loss of primary LBP were identified using Cox regression analysis.

RESULTS: In total, 236 limbs from 231 patients were included, with 52 (22%) limbs stratified as GLASS I, 59 (25%) limbs as GLASS II, and 125 (53%) limbs as GLASS III. The one-year LBP rates for limbs classified as GLASS I, II, and III were 78.8%, 69.5%, and 41.6%, respectively (P <0.001). The long-term LBP rate was 54.2% in GLASS I, 38.6% in GLASS II, and 10.5% in, GLASS III (P < 0.001). Multivariate analysis revealed that GLASS stages (GLASS Ⅰ vs GLASS Ⅲ: Hazard Ratio [HR]: 0.36; 95% Confidence Interval [CI]: 0.18-0.72; P = 0.004, GLASS Ⅱ vs GLASS Ⅲ: HR: 0.47; 95%CI: 0.25-0.86; P = 0.02), diabetes, smoking, and sex were independently associated with LBP.

CONCLUSIONS: GLASS stage III was associated with lower LBP rates in patients with CLTI who underwent EVT. The GLASS stages may serve as prognostic indicators for patients with CLTI after intervention.