The Infrapopliteal Global Limb Anatomic Staging System Predicts Wound Healing and Pain Relief after Partial Revascularization

Abstract

Chronic limb-threatening ischemia (CLTI) is frequently associated with crural artery occlusion. Complete revascularization beyond the diseased crural artery is preferable; however, complete revascularization is challenging in many cases for various reasons. On the other hand, partial reconstruction for inflow disease sometimes leads to complete relief of symptoms. It is not elucidated which patients may recover from CLTI with partial revascularization (PR). Therefore, we aimed to evaluate the factors affecting outcomes after PR. We retrospectively reviewed the medical records of patients who underwent first-attempt PR, for CLTI, for limb salvage, in our institution, between April 2012 and December 2020. We divided these 103 cases into 2 groups: the salvage group (who achieved wound healing or relief from rest pain with PR; n=81) and the nonsalvage group (who ended with major amputation or additional distal revascularization; n=22). We evaluated the factors affecting the outcome of PR in terms of patient risk, limb severity (Society for Vascular Surgery Lower Extremity Threatened Limb Classification System; wound, ischemia, and foot infection [WIfI] classification), and anatomical pattern (Global Limb Anatomic Staging System; GLASS classification). Although patient risk between the 2 groups was not statistically significant, hypoalbuminemia (< 3.0mg/dL) was more prevalent in the nonsalvage group without significance (P=0.068). Regarding limb severity status, there was no significant difference in WIfI grades. Wound grade showed the strongest correlation (P=0.11) and reduced wound grade suggested future wound healing. In terms of GLASS, infrapopliteal grade was statistically significant (P=0.033). Upon a multivariate analysis, among infrapopliteal grade, hypoalbuminemia, and wound grade, infrapopliteal grade (P=0.0096) and hypoalbuminemia (P=0.2512) revealed significant differences. Wound grade also showed correlation (P=0.085). The usefulness of the WIfI classification and GLASS classification to predict wound healing after PR for CLTI was validated.