Evaluation of glass stage in patients with chronic limb threatening ischemia treated with autogenous bypass grafts

To evaluate the relationship of GLASS stages with clinical outcomes in patients with chronic limb threatened ischemia (CLTI) submitted to distal bypasses using venous graft.A single-center retrospective analysis of patients with CLTI submitted to distal bypasses with vein graft between January 2012 and December 2019 were included. The primary end point was freedom from CLTI (amputation-free survival, with complete wound healing and without ischemic rest pain). Secondary end points included a composite outcome of recurrence (patients that achieved freedom from CLTI but developed a new wound or ischemic rest pain), major limb amputation, amputation free-survival, overall survival, major adverse limb events (MALE), limb-based patency (LBP) and primary and secondary patency rates.A total of 190 patients were submitted to 211 distal bypasses with a median follow up of 30 months. Eighty percent of the cases had diabetes or end-stage kidney disease requiring dialysis. Most patients (63%) had major or extensive tissue loss (Wound class ≥ 2) with more than half of these with some degree of infection of the foot. Severe anatomic pattern (GLASS stage III) was predominant with a prevalence of 78%. There were no significant differences between GLASS I-II and GLASS III stage groups for all the outcomes analysed. About 80% of the 211 revascularized limbs were free from CLTI at 12 months. At 4 years of follow up we observed that 25% of the cases had recurrence of CLTI, 83% were free from major amputation and 61% were free from MALE. LBP, primary patency, and secondary patency were 79%, 80% and 93% at one year, and 64%, 65% and 81% at four years, respectively.GLASS stage was not related with patency and clinical outcomes after distal bypasses with vein graft. Distal open revascularization presents excellent rates of freedom from CLTI with low rates of recurrence of CLTI, two key time-integrated outcomes of clinical disease severity in patients with CLTI.