The Relationship Between the Global Limb Anatomic Staging System (GLASS) and Midterm Outcomes of Retrograde Tibiopedal Access After Failure of Antegrade Recanalisation for Chronic Limb Threatening Ischaemia

Abstract

To examine the relationship between the Global Limb Anatomic Staging System (GLASS) and midterm limb and survival related outcomes of retrograde tibiopedal access, after failed recanalisation of infrainguinal chronic total occlusions (CTOs) using the antegrade approach, in patients with chronic limb threatening ischaemia (CLTI). This prospective, observational study was conducted between January 2017 and April 2019, and included 213 patients (29 GLASS I, 53 GLASS II, and 131 GLASS III lesions) with infrainguinal CTO in whom a percutaneous tibiopedal access was attempted following failed recanalisation using an antegrade approach. Multivariable Cox proportional hazard regression was performed to assess possible predictors of midterm clinical outcomes. Kaplan-Meier survival curves were used to estimate limb based patency (LBP), limb salvage, amputation free survival (AFS), and overall survival. The study reported access, crossing, and treatment success of 92.5%, 89.2%, and 89.2% of all tibiopedal access attempts, respectively. In comparison with GLASS I, GLASS stage III was associated with statistically significantly worse midterm LBP (p= .005), overall survival (p= .037), limb salvage (p= .021), and AFS (p < .001). Retrograde tibiopedal access for recanalisation of infrainguinal CTOs in patients with CLTI is associated with high access, crossing, and treatment success, and low complication rates. The study suggests that GLASS stage may be a useful predictor of midterm limb and survival related outcomes of this approach. In comparison with GLASS I, GLASS III anatomy is associated with a statistically significantly worse LBP, limb salvage, AFS, and overall survival.