The Global Limb Anatomic Staging System is associated with outcomes of infrainguinal revascularization in chronic limb threatening ischemia.

Abstract Objective The Global Limb Anatomic Staging System (GLASS) has been proposed to facilitate clinical decision-making in revascularization for chronic limb threatening ischemia (CLTI). The purpose of this study was to define its relationship to treatment outcomes in CLTI. Methods Consecutive patients undergoing peripheral angiography for rest pain or tissue loss between January 2017 and July 2019 at a tertiary referral center with a dedicated limb preservation program were reviewed. Subjects with significant aorto-iliac disease, prior infrainguinal stents or functioning bypass grafts, or found to have GLASS stage 0 were excluded. GLASS score was assigned based upon pre-intervention angiograms and the treating surgeon determined the primary infrapopliteal target artery pathway (TAP) for the limb at risk. Demographic data, procedural details, and clinical outcomes were analyzed. Results The study cohort consisted of 167 patients and 194 limbs, of which 175/194 (90%) presented with tissue loss and 149/182 (83%) with Wound, Ischemia and foot Infection (WIfI) Stage 3 or 4 severity. GLASS stages were 14% GLASS 1, 18% GLASS 2, and 68% GLASS 3. GLASS 3 anatomy was present in 85% of 52 limbs treated by bypass vs. 55% of 108 limbs that underwent endovascular interventions (ENDO; p Conclusions GLASS stage 3 is strongly associated with major adverse clinical outcomes following revascularization in patients with CLTI.