Introduction: Evaluate the global limb anatomic staging system (GLASS) with clinical outcomes in patients with
extensive forms of atherosclerosis submitted to infra-inguinal lesions revisited and how it affects the decision-making
and clinical outcome of the patients.
Patients and Methods: This is a prospective randomized study conducted between February 2018 and February 2022 in
a single tertiary referral center.
Results: A total of 100 patients studied 120 limbs. Their ages ranged from 45 to 77 mean of 62.2±7.44, there was male
predominance: 81 (81%) males and 19 (19%) females. According to the limb anatomic staging system, 90 (75%) of the
limbs were considered as GLASS stage III and 12 (13.3%) of these patients had femoral-popliteal GLASS stage IV with
infra-popliteal GLASS stage IV; limb-based patency (LBP) was lost in 52 (48.1%) limbs, with 20/42 (47.6%) after surgical
bypass and 32/66 (48.5%) after endovascular interventions. Most major limb amputations occurred after the loss of LBP,
17/52 (32.69%). Three patients lost their limbs with a patent reconstruction and subsequently presented with advanced
infection. All were poorly controlled diabetes who underwent revascularization for wound, ischemia, and foot infection
(WIFI) wound scores of all or higher, patients who lost LBP after either endovascular versus open revascularization were
equally likely to undergo major amputation (P=0.695). Limbs initially presenting with WIFI stage IV represent 20/29
limbs in which major limb amputations were performed in this cohort. Among these WIFI stage IV cases, 48 (55.17%)
limbs maintained LBP, and 39 (44.8%) limbs lost LBP during follow-up. WIFI stage IV limbs that lost LBP were more
likely to have undergone a major amputation at the time of data closure (P<0.001).
Conclusion: It was apparent clearly that the GLASS staging system adequately stratified the patients to be revascularized
through either endovascular intervention or bypass surgery, similar to what was published in different studies and
systematic review analyses.