The Role of Osaka Prognostic Score in Assessing Infrapopliteal Lesion Complexity and Predicting Procedural Technical Success After Endovascular Intervention: A Retrospective Study.

BACKGROUND: Peripheral artery disease (PAD) is a progressive atherosclerotic disorder affecting lower extremities. While anatomical classification systems like Trans-Atlantic Inter-Society Consensus (TASC) aid procedural planning, they lack systemic prognostic components. The Osaka Prognostic Score (OPS), incorporating C-reactive protein, albumin, and lymphocyte count, is an emerging biomarker-based index that may aid in stratifying PAD severity. This study aimed to evaluate whether OPS is associated with infrapopliteal lesion complexity and to determine its predictive value for procedural technical success in patients undergoing endovascular intervention. METHODS: This retrospective study included 154 patients undergoing lower extremity percutaneous transluminal angioplasty. Procedures were performed using standard femoral access under fluoroscopic guidance. Technical success was defined as <30% residual stenosis without impairment. The OPS was calculated preoperatively, and outcomes were analyzed. RESULTS: Higher OPS and low-density lipoprotein (LDL) levels were significantly associated with TASC C-D lesions. Technical success was significantly lower in advanced lesions. The OPS was independently associated with advanced lesion category and procedural technical failure, outperforming LDL in receiver operating characteristic analysis. CONCLUSION: The OPS was independently associated with infrapopliteal lesion complexity and procedural technical success in patients undergoing endovascular intervention for PAD. These findings suggest that OPS may serve as a useful adjunct to anatomical classification for preprocedural risk stratification. Further prospective studies with long-term clinical follow-up are needed to validate these findings.