O-032 - A COMPARISON OF 1-YEAR AMPUTATION-FREE SURVIVAL BY ANGIOGRAPHIC SCORING SYSTEM: A SYSTEMATIC REVIEW

TOPIC:
Peripheral Occlusive Arterial Disease
AUTHORS:
Vadeyar S. (Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust ~ Birmingham ~ United Kingdom) , Elsabbagh M. (Faculty of Medicine, Alexandria University ~ Alexandria ~ Egypt) , Al Shakarchi J. (Worcestershire Acute Hospitals NHS Trust ~ Worcester ~ United Kingdom) , Juszczak M. (Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust ~ Birmingham ~ United Kingdom) , Tiwari A. (Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust ~ Birmingham ~ United Kingdom)
Introduction:
Multiple angiographic scoring systems have been used to assess disease burden in peripheral arterial disease (PAD) and outcomes. There is a lack of evidence to support decision-making on which scoring system to use. The aim of this systematic review was to investigate the effect of angiographic scoring systems on 1-year amputation-free survival rates for four commonly used methods: Bollinger, TASC, ANGIO and GLASS. 
Methods:
A systematic review was conducted on 10th December 2021 of PubMed, Cochrane, Embase and MEDLINE databases using the keywords "TASC" OR "GLASS" OR "ANGIO" OR "Bollinger" AND "arterial disease" AND "amputation". Articles were limited to those after 1978, abstracts, non-research and non-English publications were excluded. The articles were independently reviewed and data was extracted by two reviewers using a standardised table. The primary outcome was 1-year amputation-free survival (AFS) and secondary outcome of interest was 1-year primary patency rate as defined by the reporting standards of the Society for Vascular Surgery. Data on association of anatomical scoring/grading with amputation-free survival were analysed using contingency tables. Pearson's Chi-squared, Fisher exact tests, and Cochran-Armitage (C-A) test for trend were used to assess the association of AFS with the anatomical disease grading.
Results:
The search yielded 247 unique records. 106 full-text articles were reviewed and 3 studies, reporting 1893 procedures, were included. Articles were excluded for the following reasons: primary outcome of interest not reported (n = 87), unable to access full-text (n = 10), incorrect study type (n = 4) and full-text not in English language (n = 2) (Figure 1). The 3 included studies were all single-centre, retrospective cohort studies describing one of the TASC, GLASS and GLASS-IM scoring systems (Table 1). No studies reporting on Bollinger or ANGIO systems fulfilled inclusion criteria. TASC classification and GLASS score were significantly associated with 1-year amputation-free survival rates (OR 2.55, 95%CI 0.85, 9.64, p=0.021, C-A p=0.003; OR 1.23, 95%CI 0.85, p=1.79, C-A p=0.014) whereas GLASS-IM was not, irrespective of whether assessed with limb or patient as the unit of analysis (OR 1.67, 95%CI 0.46, 8.24, p=0.759, C-A p=0.472; OR 1.67 95%CI 0.36, 12.97, p=0.601, C-A p=0.368).
Conclusion:
TASC and GLASS are the only systems that have any evidence of clinical outcomes. This systematic review shows that there is limited evidence to assess which angiographic scoring system is optimal in quantifying lower limb atherosclerosis, and therefore, in predicting the clinical outcomes. Further evidence is needed comparing angiographic scoring systems in terms of clinically useful outcomes such as 1-year amputation-free survival.
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