Anatomical Predictors of Endovascular Technical Success in Chronic Limb-Threatening Ischemia: The Role of GLASS and Diabetes

Background: Chronic limb-threatening ischemia (CLTI) is associated with high rates of major adverse limb events and mortality, particularly in patients with diabetes mellitus (DM). The Global Limb Anatomic Staging System (GLASS) standardizes anatomical assessment and supports revascularization planning. This study evaluated the association of anatomical complexity and diabetes with immediate technical success after infrainguinal endovascular treatment. Methods: This single-center retrospective study included 136 patients undergoing infrainguinal endovascular procedures for CLTI between May 2021 and May 2023, stratified into diabetic (n = 85) and non-diabetic (n = 51) groups. Anatomical complexity was assessed using GLASS. Technical success was defined as restoration of inline flow to the foot. Logistic regression and receiver operating characteristic analyses were performed. Results: Technical success was achieved in 74.3% of procedures, without significant differences between diabetic and non-diabetic patients (75.3% vs. 72.5%, p = 0.723). Success declined progressively from 86.3% in GLASS stage I to 75.5% in stage II and 53.1% in stage III (p = 0.003; trend p = 0.001). In multivariable analysis, GLASS FP (femoropopliteal) grade ≥2 (adjusted OR 8.068, 95% CI 3.018–21.562; p < 0.001) and tibioperoneal trunk occlusion (adjusted OR 4.874, 95% CI 1.271–18.687; p = 0.021) were independently associated with technical failure, whereas diabetes was not. The model showed good discrimination (AUC 0.820, 95% CI 0.744–0.897; p < 0.001). Conclusions: Anatomical complexity was associated with immediate technical success in CLTI, whereas no independent association with diabetes was detected in this cohort. GLASS may provide clinically relevant preprocedural risk stratification and support endovascular planning.