{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T12:21:25Z","timestamp":1789042885909,"version":"build-2803163510"},"reference-count":22,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T00:00:00Z","timestamp":1788652800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Endovasc Ther"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Although current revascularization paradigms emphasize direct inline flow through the target arterial pathway (TAP), the prognostic importance of distal pedal connectivity in this anatomical setting remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Clinical, anatomical, procedural, and follow-up characteristics were analyzed. Kaplan-Meier methods were used for time-to-event analyses, and multivariable logistic regression identified independent predictors of major amputation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      During follow-up, major amputation occurred in 29 limbs (25.7%). After multivariable adjustment, increasing Wound, Ischemia, and foot Infection (WIfI) stage was independently associated with a higher risk of major amputation (adjusted odds ratio [OR] 4.47, 95% confidence interval [CI], 2.11-9.45;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001), whereas each additional patent deep pedal arch was independently associated with a lower risk of limb loss (adjusted OR 0.23, 95% CI, 0.10-0.53;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001). Kaplan-Meier estimates demonstrated significantly better limb salvage in limbs with preserved pedal arch integrity (log-rank\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.003). At 12\u2009months, estimated amputation-free survival was 68.1%, whereas freedom from major adverse limb event among revascularized limbs was 79.7%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>In patients with isolated peroneal artery runoff, distal pedal connectivity, reflected by pedal arch integrity, and clinical severity are the principal independent predictors of limb salvage. The peroneal-based global limb anatomic staging system classification improves anatomical stratification in this selected anatomical population but does not provide independent prognostic information beyond WIfI stage and distal pedal connectivity. These findings support the systematic assessment of distal pedal circulation when planning revascularization in this challenging anatomical subgroup.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Impact<\/jats:title>\n                    <jats:p>In patients with chronic limb-threatening ischemia and isolated peroneal artery runoff, revascularization planning should extend beyond proximal anatomical complexity and include systematic assessment of distal pedal circulation. This study demonstrates that pedal arch integrity provides clinically relevant prognostic information for limb salvage, while WIfI stage remains a major determinant of amputation risk. Although application of the original GLASS framework using the peroneal artery as the target arterial pathway improves anatomical stratification, it does not independently predict limb loss. These findings support integrating clinical severity and distal pedal connectivity into treatment planning and prognostic assessment in this challenging anatomical subgroup.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15266028261479298","type":"journal-article","created":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T17:23:36Z","timestamp":1788715416000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Pedal Arch Integrity is Independently Associated With Limb Salvage in Chronic Limb-Threatening Ischemia With Isolated Peroneal Artery Runoff"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-2022-7900","authenticated-orcid":false,"given":"Laura","family":"Costa P\u00e9rez","sequence":"first","affiliation":[{"name":"Department of Angiology and Vascular Surgery, Hospital Universitari Joan XXIII, Tarragona, Spain"},{"name":"Department of Angiology and Vascular Surgery, Complejo Hospitalario Universitario de Ourense, Ourense, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8740-1573","authenticated-orcid":false,"given":"Bahaa","family":"Arefai Refai","sequence":"additional","affiliation":[{"name":"Department of Angiology and Vascular Surgery, Hospital Universitari Joan XXIII, Tarragona, Spain"},{"name":"Eastern Health Cluster, Dammam, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jes\u00fas","family":"Carnicer C\u00e1ceres","sequence":"additional","affiliation":[{"name":"Xarxa Santa Tecla Hospital, Tarragona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8119-6863","authenticated-orcid":false,"given":"Cristina","family":"Ibarz Gin\u00e9","sequence":"additional","affiliation":[{"name":"Xarxa Santa Tecla Hospital, Tarragona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ra\u00fal Vidal","family":"Garc\u00eda","sequence":"additional","affiliation":[{"name":"Department of Angiology and Vascular Surgery, Hospital Universitari Joan XXIII, Tarragona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,6]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2019.02.016"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2024.02.013"},{"issue":"2","key":"e_1_3_2_4_2","first-page":"239","article-title":"Relationship between GLASS stage and angiosome-based target arterial pathway in patients with chronic limb-threatening ischemia","volume":"63","author":"Yamada T","year":"2022","unstructured":"Yamada T, Takahara M, Iida O, et al. Relationship between GLASS stage and angiosome-based target arterial pathway in patients with chronic limb-threatening ischemia. Eur J Vasc Endovasc Surg. 2022;63(2):239-247.","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1148\/rg.316115511"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0034-1393967"},{"key":"e_1_3_2_7_2","first-page":"861","article-title":"Pedal arch classification and its relationship with wound healing after infrapopliteal intervention","volume":"80","author":"Kawarada O","year":"2012","unstructured":"Kawarada O, Yokoi Y, Higashimori A, et al. Pedal arch classification and its relationship with wound healing after infrapopliteal intervention. Catheter Cardiovasc Interv. 2012;80:861-871.","journal-title":"Catheter Cardiovasc Interv"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1996.01430200104018"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/0741-5214(94)90132-5"},{"issue":"5","key":"e_1_3_2_10_2","first-page":"414","volume":"6","author":"Shortell CK","year":"1992","unstructured":"Shortell CK, DeWeese JA, Ouriel K, et al. Ann Vasc Surg. 1992;6(5):414-419.","journal-title":"Ann Vasc Surg"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2008.02.070"},{"issue":"1","key":"e_1_3_2_12_2","first-page":"136","article-title":"Evaluation of the peroneal artery as a target for infrainguinal bypass","volume":"53","author":"Abularrage CJ","year":"2011","unstructured":"Abularrage CJ, Sidawy AN, Aidinian G, Singh N, Weiswasser JM, Arora S. Evaluation of the peroneal artery as a target for infrainguinal bypass. J Vasc Surg. 2011;53(1):136-141.","journal-title":"J Vasc Surg"},{"key":"e_1_3_2_13_2","doi-asserted-by":"crossref","unstructured":"Mohapatra A Boitet A Malak O et al. Peroneal bypass versus endovascular peroneal intervention for critical limb ischemia. J Vasc Surg. 2019;69(1):148-155.","DOI":"10.1016\/j.jvs.2018.04.049"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2012.10.129"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1177\/145749691210100209"},{"key":"e_1_3_2_16_2","first-page":"566","article-title":"Angiosome-guided revascularization in chronic limb-threatening ischemia: does it improve outcomes?","volume":"72","author":"Alexandrescu V","year":"2021","unstructured":"Alexandrescu V, S\u00f6derstr\u00f6m M, Venermo M. Angiosome-guided revascularization in chronic limb-threatening ischemia: does it improve outcomes? Ann Vasc Surg. 2021;72:566-574.","journal-title":"Ann Vasc Surg"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2011.08.014"},{"issue":"3","key":"e_1_3_2_18_2","first-page":"376","article-title":"Angiosome-oriented or least diseased vessel as target arterial pathway for revascularization in chronic limb-threatening ischemia","volume":"65","author":"Hou Z","year":"2023","unstructured":"Hou Z, Zhang X, Li Y, et al. Angiosome-oriented or least diseased vessel as target arterial pathway for revascularization in chronic limb-threatening ischemia. Eur J Vasc Endovasc Surg. 2023;65(3):376-384.","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1177\/1526602820963932"},{"issue":"3","key":"e_1_3_2_20_2","first-page":"331","article-title":"Clinical results of below-the-knee intervention using pedal-plantar loop technique for the revascularization of foot arteries","volume":"50","author":"Manzi M","year":"2009","unstructured":"Manzi M, Fusaro M, Ceccacci T, Erente G, Dalla Paola L, Brocco E. Clinical results of below-the-knee intervention using pedal-plantar loop technique for the revascularization of foot arteries. J Cardiovasc Surg. 2009;50(3):331-337.","journal-title":"J Cardiovasc Surg"},{"issue":"1","key":"e_1_3_2_21_2","first-page":"28","article-title":"Singularities of the pedal circulation in CLTI: time for novel merging guidelines","volume":"3","author":"Alexandrescu VA","year":"2023","unstructured":"Alexandrescu VA, Kerzmann A, Boesmans E, et al. Singularities of the pedal circulation in CLTI: time for novel merging guidelines. J Crit Limb Ischemia. 2023;3(1):28-36.","journal-title":"J Crit Limb Ischemia"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0741-5214(97)70045-4"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2017.04.074"}],"container-title":["Journal of Endovascular Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15266028261479298","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/15266028261479298","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15266028261479298","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T12:02:10Z","timestamp":1789041730000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/15266028261479298"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,6]]},"references-count":22,"alternative-id":["10.1177\/15266028261479298"],"URL":"https:\/\/doi.org\/10.1177\/15266028261479298","relation":{},"ISSN":["1526-6028","1545-1550"],"issn-type":[{"value":"1526-6028","type":"print"},{"value":"1545-1550","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,6]]},"article-number":"15266028261479298"}}