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

  • Sohei Matsuura
    Affiliations
    Department of Vascular Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan

    Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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  • Takuya Hashimoto
    Affiliations
    Department of Vascular Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
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  • Masamitsu Suhara
    Affiliations
    Department of Vascular Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
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  • Juno Deguchi
    Correspondence
    Correspondence to: Juno Deguchi, MD, PhD, Department of Vascular Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan, 1981 Kamoda, Kawagoe, Saitama 350-8550, Japan
    Affiliations
    Department of Vascular Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
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Published:September 01, 2022DOI:https://doi.org/10.1016/j.avsg.2022.07.015

      Highlights

      • Reduced GLASS IP grade severity meant good candidacy for partial revascularization.
      • Degree of infrapopliteal arterial lesion is crucial for revascularization for CLTI.
      • This validated WIfI classification and GLASS for wound healing prediction postoperatively.

      Background

      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.

      Methods

      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).

      Results

      Although patient risk between the 2 groups was not statistically significant, hypoalbuminemia (< 3.0 mg/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).

      Conclusions

      The usefulness of the WIfI classification and GLASS classification to predict wound healing after PR for CLTI was validated.
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      References

        • Conte M.S.
        • Bradbury A.W.
        • Kolh P.
        • et al.
        Global vascular guidelines on the management of chronic limb-threatening ischemia.
        J Vasc Surg. 2019; 69: 3S-125S.e40
        • Conte M.S.
        • Bradbury A.W.
        • Kolh P.
        • et al.
        Global vascular guidelines on the management of chronic limb-threatening ischemia.
        Eur J Vasc Endovasc Surg. 2019; 58: S1-S109.e33
        • Mills J.L.
        • Conte M.S.
        • Armstrong D.G.
        • et al.
        The society for vascular surgery lower extremity threatened limb classification system: risk stratification based on Wound, Ischemia, and foot Infection (WIfI).
        J Vasc Surg. 2014; 59: 220-234.e1-2
        • Norgren L.
        • Hiatt W.R.
        • Bell K.
        • et al.
        Inter-Society consensus for the management of peripheral arterial disease (TASC II).
        Eur J Vasc Endovasc Surg. 2007; 33: S5-S67
        • Morisaki K.
        • Furuyama T.
        • Matsubara Y.
        • et al.
        Thigh sarcopenia and hypoalbuminemia predict impaired overall survival after infrainguinal revascularization in patients with critical limb ischemia.
        Vascular. 2020; 28: 542-547
        • Bath J.
        • Smith J.B.
        • Woodard J.
        • et al.
        Complex relationship between low albumin level and poor outcome after lower extremity procedures for peripheral artery disease.
        J Vasc Surg. 2021; 73: 200-209
        • Peacock M.R.
        • Farber A.
        • Eslami M.H.
        • et al.
        Hypoalbuminemia predicts perioperative morbidity and mortality after infrainguinal lower extremity bypass for critical limb ischemia.
        Ann Vasc Surg. 2017; 41: 169-175.e4
        • Furuyama T.
        • Onohara T.
        • Yamashita S.
        • et al.
        Prognostic factors of ulcer healing and amputation-free survival in patients with critical limb ischemia.
        Vascular. 2018; 26: 626-633
        • Causey M.W.
        • Wu B.
        • Dini M.
        • et al.
        RR21. Society for Vascular Surgery (SVS) lower extremity threatened limb classification discriminates early outcomes in hospitalized patients.
        J Vasc Surg. 2014; 59: 103S-104S
        • Cull D.L.
        • Manos G.
        • Hartley M.C.
        • et al.
        An early validation of the society for vascular surgery lower extremity threatened limb classification system.
        J Vasc Surg. 2014; 60: 1535-1542
        • Darling J.D.
        • McCallum J.C.
        • Soden P.A.
        • et al.
        Predictive ability of the Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification system after first-time lower extremity revascularizations.
        J Vasc Surg. 2017; 65: 695-704
        • Mayor J.M.
        • Valentin W.
        • Sharath S.
        • et al.
        The impact of foot infection on infrainguinal bypass outcomes in patients with chronic limb-threatening ischemia.
        J Vasc Surg. 2018; 68: 1841-1847
        • Mathioudakis N.
        • Hicks C.W.
        • Canner J.K.
        • et al.
        The Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification system predicts wound healing but not major amputation in patients with diabetic foot ulcers treated in a multidisciplinary setting.
        J Vasc Surg. 2017; 65: 1698-1705.e1
        • Liang P.
        • Marcaccio C.L.
        • Darling J.D.
        • et al.
        Validation of the global limb anatomical staging system in first-time lower extremity revascularization.
        J Vasc Surg. 2021; 73: 1683-1691.e1