PMID- 37753707
OWN - NLM
STAT- Publisher
LR  - 20230927
IS  - 1545-1550 (Electronic)
IS  - 1526-6028 (Linking)
DP  - 2023 Sep 27
TI  - The Relationship Between the Global Limb Anatomic Staging System and Midterm 
      Outcomes of Subintimal Angioplasty of Superficial Femoral Artery Atherosclerotic 
      Disease in Chronic Limb Threatening Ischemia.
PG  - 15266028231200466
LID - 10.1177/15266028231200466 [doi]
AB  - BACKGROUND: Superficial femoral artery (SFA) is commonly affected with 
      atherosclerotic peripheral arterial disease leading to chronic limb-threatening 
      ischemia (CLTI). Subinitimal angioplasty (SIA) is a minimally invasive option. We 
      aimed to examine the relationship between the Global Limb Anatomic Staging System 
      and SIA midterm limb and survival-related outcomes. METHOD: A prospective 
      observational study was conducted on all patients with CLTI (Rutherford 4-6 or 
      WIFI stages 2-4), with diseased femoropopliteal segment underwent SIA from August 
      2020 to September 2021. Patients with non-atherosclerotic SFA occlusion and those 
      requiring primary major amputation were excluded. 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. 
      RESULTS: The study included 138 patients with CLTI due to chronic total occlusion 
      of the SFA and underwent SIA +/- treatment of associated ipsilateral 
      hemodynamically significant inflow/outflow disease. Primary technical success was 
      achieved in 116 cases (84%), with primary patency at 1, 6, and 12 months being 
      100%, 84%, and 79% respectively, while the limb-salvage rate at 6 and 12 months 
      was 100% and 94%, respectively. The result of the comparison between CLASS 1 and 
      Global Limb Anatomic Staging System III (GLASS III) revealed significantly worse 
      patency with GLASS III (p=0.005), and better overall survival (p=0.037), limb 
      salvage (p=0.021), and AFS (p<0.001) with GLASS I. CONCLUSION: Subinitimal 
      angioplasty is a safe, effective, and minimally invasive treatment option for 
      lengthy SFA lesions by avoiding the patients' anesthesia and operative risk. Our 
      study suggests that the GLASS stage may be a useful predictor of midterm limb and 
      survival-related outcomes of this approach. GLASS III anatomy in comparison with 
      GLASS I is associated with a statistically significantly worse LBP, limb salvage, 
      AFS, and overall survival. CLINICAL IMPACT: This study is discussing a very hot 
      interesting challenging topic in vascular surgery and its management as SFA 
      atherosclerotic lesion is the most common lesion faced by vascular surgeons 
      subintimal angioplasty SIA is considered feasible and effective method in dealing 
      with this lesion with accepted durability and lower rates of complications.The 
      subintimal angioplasty is made by opening an extraluminal track behind the 
      intimal layer and between the media and intima of the artery surrounding 
      atherosclerotic plaque and thrombus. Hence, the track has a low thrombus or 
      plaque burden content, making the SIA easier than intraluminal angioplasty and 
      with comparable results. GLASS stage III was an independent predictor of loss of 
      LBP, worse AFS, and major amputation.
FAU - Shahat, Mohammed
AU  - Shahat M
AUID- ORCID: 0000-0002-7087-8674
AD  - Department of Vascular and Endovascular Surgery, Faculty of Medicine, Assiut 
      University Hospitals, Assiut University, Assiut, Egypt.
FAU - Atalla, Khaled
AU  - Atalla K
AD  - Department of Vascular and Endovascular Surgery, Faculty of Medicine, Assiut 
      University Hospitals, Assiut University, Assiut, Egypt.
FAU - Abdelmonem, Mostafa
AU  - Abdelmonem M
AD  - Department of Vascular and Endovascular Surgery, Faculty of Medicine, Assiut 
      University Hospitals, Assiut University, Assiut, Egypt.
FAU - Khairy, Ahmed
AU  - Khairy A
AUID- ORCID: 0000-0002-1849-9431
AD  - Department of Vascular and Endovascular Surgery, Faculty of Medicine, Assiut 
      University Hospitals, Assiut University, Assiut, Egypt.
LA  - eng
PT  - Journal Article
DEP - 20230927
PL  - United States
TA  - J Endovasc Ther
JT  - Journal of endovascular therapy : an official journal of the International 
      Society of Endovascular Specialists
JID - 100896915
SB  - IM
OTO - NOTNLM
OT  - GLASS
OT  - SFA atherosclerotic disease
OT  - chronic limb-threatening ischemia
OT  - subinitimal angioplasty
EDAT- 2023/09/27 06:42
MHDA- 2023/09/27 06:42
CRDT- 2023/09/27 05:30
PHST- 2023/09/27 06:42 [medline]
PHST- 2023/09/27 06:42 [pubmed]
PHST- 2023/09/27 05:30 [entrez]
AID - 10.1177/15266028231200466 [doi]
PST - aheadofprint
SO  - J Endovasc Ther. 2023 Sep 27:15266028231200466. doi: 10.1177/15266028231200466.