A systematic review and meta-analysis of prognosis and revascularization strategies in chronic limb-threatening ischemia according to the global limb anatomical staging system.
Carlos B Melo, Dilson Pimentel-Junior, Mariana K Obara et al.
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In 30 seconds
This systematic review and meta-analysis assessed the prognostic value of GLASS anatomical stage and compared revascularization strategies in chronic limb-threatening ischemia. Across 17 studies involving 5290 patients and 5492 limbs, greater anatomical severity was associated with lower immediate technical success after endovascular treatment and higher hazard of limb-based patency failure. In GLASS III disease, endovascular treatment was associated with a higher hazard of major adverse limb events than open bypass (HR, 1.88; 95% CI, 1.35-2.61; P = .015); other compared outcomes did not differ significantly.
Key findings
- GLASS III versus GLASS I was associated with higher hazards of mortality (HR, 1.28; 95% CI, 1.06-1.56; P = .021), MALE (HR, 1.36; 95% CI, 1.02-1.83; P = .042), and limb-based patency failure (HR, 2.23; 95% CI, 1.56-3.19; P = .003).
- Immediate technical success declined with stage: GLASS I had higher rates than GLASS II (RR, 1.03; 95% CI, 1.01-1.05; P = .016) and GLASS III (RR, 1.24; 95% CI, 1.09-1.41; P = .005); GLASS II also exceeded GLASS III (RR, 1.20; 95% CI, 1.04-1.38; P = .017).
- Among GLASS III patients, endovascular treatment was associated with greater MALE hazard than open bypass (HR, 1.88; 95% CI, 1.35-2.61; P = .015); other outcomes showed no significant differences.
Why it matters
GLASS stage may help frame prognosis by identifying anatomical complexity associated with technical success and limb-based patency outcomes. The comparison in GLASS III also highlights a potential difference in MALE between endovascular treatment and bypass, while the absence of significant differences in other outcomes cautions against interpreting this as broad superiority of one strategy.
What to keep in mind
The findings synthesize 17 studies, and the abstract does not specify whether the treatment comparisons were randomized; the GLASS III strategy findings should therefore be interpreted as associations.