PMID- 35953002
OWN - NLM
STAT- MEDLINE
DCOM- 20230227
LR  - 20230303
IS  - 1097-6809 (Electronic)
IS  - 0741-5214 (Linking)
VI  - 77
IP  - 3
DP  - 2023 Mar
TI  - A systematic review and meta-analysis of GLASS staging system in the endovascular 
      treatment of chronic limb-threatening ischemia.
PG  - 957-963.e3
LID - S0741-5214(22)02089-4 [pii]
LID - 10.1016/j.jvs.2022.07.183 [doi]
AB  - OBJECTIVE: The objective of this study was to evaluate the application of the 
      Global Anatomic Staging System (GLASS) in the endovascular treatment of chronic 
      limb-threatening ischemia (CLTI). METHODS: We performed systematic research 
      between June 2019 and February 2022, including articles investigating the 
      relationship of GLASS classification with the outcomes of endovascular 
      interventions in the treatment of CLTI. Data from the included studies were 
      pooled and meta-analyzed. The primary endpoints were limb-based patency (LBP) at 
      1-year follow-up and immediate technical failure (ITF). Secondary endpoints 
      included major amputation. We performed subgroup analysis between studies that 
      reported on calcium modifier inclusion during GLASS classification and studies 
      that did not. RESULTS: Eleven studies, including 1816 patients (1975 limbs) met 
      the inclusion criteria. The pooled ITF rates for GLASS stages I, II, and III are 
      5.52% (95% confidence interval [CI], 3.74%-8.07%), 7.39% (95% CI, 5.32%-10.18%), 
      and 21.07% (95% CI, 13.48%-31.39%) respectively. The pooled LBP for GLASS stages 
      I, II, and III are 68.43% (95% CI, 53.44%-80.37%), 41.52% (95% CI, 
      18.91%-68.37%), and 38.64% (95% CI, 19.83%-61.57%). The relative risk (RR) for 
      ITF regarding composite GLASS I and II stages vs GLASS III is 3.96 (95% CI, 
      1.96-7.98). The RR for LBP of GLASS I and II versus GLASS stage III is 1.51 (95% 
      CI, 0.86-2.64). Pooled major amputation rates for the composite GLASS I, II and 
      GLASS III stages are 7.62% (95% CI, 5.44%-10.58%) and 15.43% (95% CI, 
      11.72%-20.05%) respectively, whereas the RR between GLASS I, II, and GLASS III 
      stages is 1.84 (95% CI, 1.18-2.87). CONCLUSIONS: Our study demonstrated that 
      patients with CLTI undergoing endovascular interventions classified as GLASS 
      stage III had almost a four-fold risk increase for ITF and 1.84 times the risk of 
      major amputation compared with stages I and II. Additionally, GLASS 
      classification correctly predicted ITF for all three stages, whereas it failed to 
      predict stage I and II LBP outcomes. Safe conclusions regarding LBP cannot be 
      drawn due to the low quality and small number of the included studies, 
      necessitating further research. Furthermore, we displayed the importance of 
      calcium moderator inclusion in the accurate classification of GLASS.
CI  - Copyright (c) 2022 Society for Vascular Surgery. Published by Elsevier Inc. All 
      rights reserved.
FAU - Bontinis, Vangelis
AU  - Bontinis V
AD  - Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA 
      University General Hospital, Thessaloniki, Greece. Electronic address: 
      vangelisbont@hotmail.com.
FAU - Bontinis, Alkis
AU  - Bontinis A
AD  - Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA 
      University General Hospital, Thessaloniki, Greece.
FAU - Koutsoumpelis, Andreas
AU  - Koutsoumpelis A
AD  - Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA 
      University General Hospital, Thessaloniki, Greece.
FAU - Giannopoulos, Argirios
AU  - Giannopoulos A
AD  - Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA 
      University General Hospital, Thessaloniki, Greece.
FAU - Ktenidis, Kiriakos
AU  - Ktenidis K
AD  - Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA 
      University General Hospital, Thessaloniki, Greece.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20220808
PL  - United States
TA  - J Vasc Surg
JT  - Journal of vascular surgery
JID - 8407742
RN  - SY7Q814VUP (Calcium)
SB  - IM
MH  - Humans
MH  - Chronic Limb-Threatening Ischemia
MH  - *Endovascular Procedures
MH  - Treatment Outcome
MH  - Calcium
MH  - Risk Factors
MH  - Limb Salvage
MH  - Ischemia
MH  - *Peripheral Arterial Disease
MH  - Retrospective Studies
MH  - Chronic Disease
OTO - NOTNLM
OT  - Chronic limb-threatening ischemia
OT  - Endovascular
OT  - Global Limb Anatomic Staging System
OT  - Global vascular guidelines
EDAT- 2022/08/12 06:00
MHDA- 2023/03/03 06:00
CRDT- 2022/08/11 19:37
PHST- 2022/03/30 00:00 [received]
PHST- 2022/06/12 00:00 [revised]
PHST- 2022/07/18 00:00 [accepted]
PHST- 2022/08/12 06:00 [pubmed]
PHST- 2023/03/03 06:00 [medline]
PHST- 2022/08/11 19:37 [entrez]
AID - S0741-5214(22)02089-4 [pii]
AID - 10.1016/j.jvs.2022.07.183 [doi]
PST - ppublish
SO  - J Vasc Surg. 2023 Mar;77(3):957-963.e3. doi: 10.1016/j.jvs.2022.07.183. Epub 2022 
      Aug 8.