Evaluation of global vascular guidelines strategy in infra-inguinal occlusive disease: Revisited using global limb anatomic staging system.

Introduction: Evaluate the global limb anatomic staging system (GLASS) with clinical outcomes in patients withextensive forms of atherosclerosis submitted to infra-inguinal lesions revisited and how it affects the decision-makingand clinical outcome of the patients.Patients and Methods: This is a prospective randomized study conducted between February 2018 and February 2022 ina single tertiary referral center.Results: A total of 100 patients studied 120 limbs. Their ages ranged from 45 to 77 mean of 62.2±7.44, there was malepredominance: 81 (81%) males and 19 (19%) females. According to the limb anatomic staging system, 90 (75%) of thelimbs were considered as GLASS stage III and 12 (13.3%) of these patients had femoral-popliteal GLASS stage IV withinfra-popliteal GLASS stage IV; limb-based patency (LBP) was lost in 52 (48.1%) limbs, with 20/42 (47.6%) after surgicalbypass and 32/66 (48.5%) after endovascular interventions. Most major limb amputations occurred after the loss of LBP,17/52 (32.69%). Three patients lost their limbs with a patent reconstruction and subsequently presented with advancedinfection. All were poorly controlled diabetes who underwent revascularization for wound, ischemia, and foot infection(WIFI) wound scores of all or higher, patients who lost LBP after either endovascular versus open revascularization wereequally likely to undergo major amputation (P=0.695). Limbs initially presenting with WIFI stage IV represent 20/29limbs in which major limb amputations were performed in this cohort. Among these WIFI stage IV cases, 48 (55.17%)limbs maintained LBP, and 39 (44.8%) limbs lost LBP during follow-up. WIFI stage IV limbs that lost LBP were morelikely to have undergone a major amputation at the time of data closure (P<0.001).Conclusion: It was apparent clearly that the GLASS staging system adequately stratified the patients to be revascularizedthrough either endovascular intervention or bypass surgery, similar to what was published in different studies andsystematic review analyses.