Anatomical complexity was associated with immediate technical success in CLTI, whereas no independent association with diabetes was detected in this cohort.
Key Findings
Results
Overall immediate technical success of infrainguinal endovascular treatment for CLTI was 74.3%, with no significant difference between diabetic and non-diabetic patients.
Single-center retrospective study of 136 patients treated between May 2021 and May 2023.
Patients were stratified into diabetic (n = 85) and non-diabetic (n = 51) groups.
Technical success was defined as restoration of inline flow to the foot.
Success was 75.3% in diabetic vs. 72.5% in non-diabetic patients (p = 0.723).
Results
Technical success declined progressively with higher GLASS stage.
Success was 86.3% in GLASS stage I, 75.5% in stage II and 53.1% in stage III (p = 0.003).
The test for trend was significant (trend p = 0.001).
Anatomical complexity was assessed using the Global Limb Anatomic Staging System (GLASS).
Results
GLASS femoropopliteal (FP) grade ≥2 was independently associated with technical failure in multivariable analysis.
Adjusted OR 8.068 (95% CI 3.018-21.562; p < 0.001).
Derived from multivariable logistic regression.
Results
Tibioperoneal trunk occlusion was independently associated with technical failure.
Adjusted OR 4.874 (95% CI 1.271-18.687; p = 0.021).
Identified in multivariable logistic regression alongside GLASS FP grade ≥2.
Results
Diabetes mellitus was not independently associated with technical failure in the multivariable model.
Unadjusted technical success did not differ by diabetes status (75.3% vs. 72.5%, p = 0.723).
The authors state no independent association with diabetes was detected in this cohort.
Results
The multivariable model showed good discrimination for technical outcome.
AUC 0.820 (95% CI 0.744-0.897; p < 0.001) from receiver operating characteristic analysis.
Conclusions
The authors conclude GLASS may provide clinically relevant preprocedural risk stratification and support endovascular planning.
Conclusion based on the association of anatomical complexity with immediate technical success.
Study is single-center and retrospective, limiting generalizability.
What This Means
This study looked at 136 patients with chronic limb-threatening ischemia, a severe form of poor leg circulation, who had minimally invasive procedures to reopen blocked leg arteries between 2021 and 2023. About 85 had diabetes and 51 did not. The researchers wanted to know what predicts whether the procedure immediately succeeds in restoring blood flow to the foot.
Overall, the procedure succeeded in about three out of four patients (74.3%), and the rate was similar in people with and without diabetes. What mattered more was how complex the artery blockages were. Using a standard scoring system called GLASS, success dropped from 86% in the least complex stage to 53% in the most complex stage. Severe disease in the femoropopliteal arteries (above and around the knee) and blockage of the tibioperoneal trunk (a key artery below the knee) were each strongly linked with failure, and a model combining anatomical factors predicted outcomes reasonably well.
This research suggests that mapping the anatomy of the blockages before a procedure may help doctors anticipate how likely it is to succeed and plan treatment. Because this was a retrospective study at a single center and measured only immediate technical success, not long-term limb outcomes, the findings should be interpreted cautiously, and diabetes may still matter for other outcomes not assessed here.
Dumitrescu-Bordianu A, Baroi L, Popa R, Iacob L, Caba B, Morariu P, et al.. (2026). Anatomical Predictors of Endovascular Technical Success in Chronic Limb-Threatening Ischemia: The Role of GLASS and Diabetes.. Medical sciences (Basel, Switzerland). https://doi.org/10.3390/medsci14060614