Clinical Outcomes of Infrapopliteal Angioplasty in Chronic Limb-threatening Ischemia: A Global Limb Anatomic Staging System Staging Perspective

Background: Chronic limb-threatening ischemia (CLTI) represents the most advanced stage of peripheral arterial disease, with limited revascularization options in infrapopliteal disease. Balloon angioplasty is increasingly adopted as a limb salvage strategy. We assessed outcomes of infrapopliteal angioplasty, with emphasis on global limb anatomic staging system (GLASS) staging, wound, ischemia, and foot infection (WIfI) classification, and pedal arch anatomy. Materials and Methods: A retrospective study was conducted on 46 patients undergoing isolated infrapopliteal angioplasty. Patients were stratified using GLASS, WIfI classification, and pedal arch type. Outcomes included technical success, ankle–brachial index (ABI) change, wound healing, limb salvage, and amputation rates. Results: Mean age was 62 ± 8.7 years; 91.3% were male, and 84.8% were diabetic. Rutherford Category 5 and 6 ischemia were seen in 65.2% and 34.8%, respectively. GLASS Stage III was the most common (52.2%). Technical success was 95.7%, with failures confined to Stage III. Mean ABI improved from 0.57 ± 0.14 to 0.82 ± 0.12 ( P < 0.001). Wound healing occurred in 73.9%, and limb salvage was 93.5%. Pedal arch was complete in 39.1%, incomplete in 43.5%, and absent in 17.4%. A complete arch correlated with better wound healing and limb salvage. All major amputations (6.5%) occurred in WIfI Stage four patients. Conclusion: Isolated infrapopliteal angioplasty offers high technical success and effective limb salvage in CLTI, particularly for patients unsuitable for surgical revascularization. The combined use of GLASS staging, pedal arch anatomy, and WIfI classification enhances prognostic accuracy and supports individualized treatment planning, which is especially relevant in resource-limited settings.