O-141 - LONG-TERM RESULTS OF ENDOVASCULAR PROCEDURES ON INFRAINGUINAL GLOBAL LIMB ANATOMICAL STAGING SYSTEM (GLASS) GRADE 3-4 PATIENTS IN A SINGLE-CENTER EXPERIENCE.

TOPIC:
Peripheral Occlusive Arterial Disease
AUTHORS:
Vacca F. (Vascular and Endovascular Surgery - Department of Emergency and Organs Transplantation, "Aldo Moro" University of Bari School of Medicine, Bari, Italy. ~ Bari ~ Italy) , Zacà S. (Vascular and Endovascular Surgery - Department of Emergency and Organs Transplantation, "Aldo Moro" University of Bari School of Medicine, Bari, Italy. ~ Bari ~ Italy) , Ramundo R.M. (Vascular and Endovascular Surgery - Department of Emergency and Organs Transplantation, "Aldo Moro" University of Bari School of Medicine, Bari, Italy. ~ Bari ~ Italy) , Ringold M. (Vascular and Endovascular Surgery - Department of Emergency and Organs Transplantation, "Aldo Moro" University of Bari School of Medicine, Bari, Italy. ~ Bari ~ Italy) , Sodero F. (Vascular and Endovascular Surgery - Department of Emergency and Organs Transplantation, "Aldo Moro" University of Bari School of Medicine, Bari, Italy. ~ Bari ~ Italy) , Passabì M. (Vascular and Endovascular Surgery - Department of Emergency and Organs Transplantation, "Aldo Moro" University of Bari School of Medicine, Bari, Italy. ~ Bari ~ Italy) , Chiarelli A. (Vascular and Endovascular Surgery - Department of Emergency and Organs Transplantation, "Aldo Moro" University of Bari School of Medicine, Bari, Italy. ~ Bari ~ Italy) , Angiletta D. (Vascular and Endovascular Surgery - Department of Emergency and Organs Transplantation, "Aldo Moro" University of Bari School of Medicine, Bari, Italy. ~ Bari ~ Italy)
Introduction:
The Global Vascular Guidelines aim the decision making in Chronic Limb-Threatening Ischemia (CLTI) by providing a framework for evidence-based revascularization (EBR). The Global Limb Anatomic Staging System (GLASS) estimates the extent and anatomical distribution of the infrainguinal obstructive lesions reflecting the type of surgical revascularization. Aim of the study is to report the long-term outcomes following endovascular procedures on infrainguinal GLASS grade 3-4.
Methods:
This is an observational, retrospective, single-center experience of a tertiary referral center. From January 2016 to January 2022, all patients with CLTI affected by infrainguinal disease were indentified. Infrainguinal GLASS grade 3 and 4 cases were split in the group A and B, respectively. Over a series of 316 patients, 71 and 80 cases were included in the "A group" and "B group", respectively. A comparison between the two groups was conducted for demographics and operative details. Immediate outcomes were defined by technical and hemodynamic success (ankle-brachial index, ABI, improvement). Early outcomes were evaluated at 30 days in terms of mortality, thrombosis, reintervention and amputation (minor and major). Late results were analyzed at 5 years of follow-up in terms of overall and groups estimations. Late results were defined by survival (all-cause mortality), freedom from target lesion revascularization (ff-TLR), freedom from reintervention (ff-R), late lumen loss and freedom from minor or major amputation. Data were analyzed by chi-square test and Fisher's exact test when needed. All p-values were two-sided and a p<0.05 was considered significant. Follow-up data were analyzed with Kaplan-Meier event-time survival curves and the groups were compared with log-rank test.
Results:
Mean age was 71.2±10.3. No significant differences were observed in terms of Rutherford's clinical stage (p= .332), Rutherford's 4-5-6 categories were observed in 35 (23.1%), 91 (60.3%) and 25 (16.6%) patients, respectively. Groups were homogeneous for baseline characteristics apart from chronic obstructive lung disease COPD (p= .008) and Diabetes (p= 0.045) that affected mainly the B group. 128 (84.7%) balloon angioplasty (108 plain old balloon angioplasty POBA - 20 drug eluting balloon DEB) and 23 (15.3%) stent implantation (6 bare metal stent BMS - 17 drug eluting stent DES) were performed. Stent implantation was performed only for residual significant stenosis after POBA/DEB and in case of flow-limiting dissection after subintimal recanalization. The groups differ for type of balloon angioplasty (p= .019) in fact B group underwent to DEB angioplasy in the majority of cases. Technical success was achieved in 135 (89.4%) cases and hemodynamical success showed an ABI significant improvement (pre-operative vs post-operative, 0.25±0.17 vs 0.63±0.34, p= .001). Early results showed 3 (1.9%) deaths, 9 (5.9%) thromboses, 2 (1.3%) reinterventions, 5 (3.3%) minor and 5 (3.3%) major amputations. Groups did not differ significantly for early results. Mean age of follow up was 26±10 months. Overall survival was 61% and estimations did not differ between the groups (log-rank .184, p= .668). Overall ff-TLR was 57.2% with no differences between the groups (log-rank 1.555, p= .212). Overall LLL was 70.1% and LLL was observed mainly in the B group but data did not show significant differences (log-rank 3.456, p= .063). Overall ff-R was 53.4% without any differences between the groups (log-rank 1.866, p= .195). Overall freedom from amputation was 70.9% for major and 80.5% for minor. Minor amputation affected mainly A group (ff-amputation A vs B, 68.2% vs 90.3%, log-rank 5.156, p= .023). No differences were observed for major amputations in the two groups (log-rank 2.470, p= .116).
Conclusion:
The study highlighted the differences in complex infrainguinal GLASS grades. Moreover, long-term results of endovascular procedures reflected the new GLOBAL indications for surgery. In fact, worsening outcomes by endovascular surgery might be replaced by better outcomes if selected patients had been underwent to traditional surgical revascularizations. Despite the patency outcomes (ff-TLR and LLL), limb salvage rate was acceptable and in-line with other series in literature.