SEGMENTAL VASCULAR BURDEN AND OUTCOMES IN DIABETIC VS. NON-DIABETIC CHRONIC LIMB-THREATENING ISCHEMIA AFTER ENDOVASCULAR REVASCULARIZATION

Authors

  • Anca DUMITRESCU-BORDIANU Grigore T. Popa University of Medicine and Pharmacy Iasi, Romania
  • Livia Genoveva BAROI Grigore T. Popa University of Medicine and Pharmacy Iasi, Romania
  • R. F. POPA Grigore T. Popa University of Medicine and Pharmacy Iasi, Romania
  • L. IACOB Grigore T. Popa University of Medicine and Pharmacy Iasi, Romania
  • Daniela JARDAN Grigore T. Popa University of Medicine and Pharmacy Iasi, Romania
  • Cristina DASCĂLU Grigore T. Popa University of Medicine and Pharmacy Iasi, Romania
  • B. M. CIUNTU Grigore T. Popa University of Medicine and Pharmacy Iasi, Romania
  • L. M. ABDULAN Grigore T. Popa University of Medicine and Pharmacy Iasi, Romania
  • Paula-Cristina MORARIU
  • Maria Mihaela GODUN Grigore T. Popa University of Medicine and Pharmacy Iasi, Romania
  • A.-F OANCEA Grigore T. Popa University of Medicine and Pharmacy Iasi, Romania
  • A. BURLACU Grigore T. Popa University of Medicine and Pharmacy Iasi, Romania
  • Daniela Maria TANASE Grigore T. Popa University of Medicine and Pharmacy Iasi, Romania
  • Mariana FLORIA Grigore T. Popa University of Medicine and Pharmacy Iasi, Romania

DOI:

https://doi.org/10.22551/MSJ.2026.02.10

Abstract

Peripheral artery disease (PAD) progressing to chronic limb-threatening ischemia (CLTI) is associated with high morbidity and limb loss. Diabetes mellitus (DM) significantly influences disease distribution and clinical outcomes. The Bollinger score, GLASS classification, and WIfI staging are complementary tools for assessing anatomical burden and limb threat. This study aimed to analyze the relationships between these scoring systems in diabetic CLTI, with particular focus on infra-popliteal versus global anatomical evaluation. Materials and methods: This single-center retrospective study included 136 patients with CLTI undergoing endovascular revascularization between May 2021 and May 2023. Baseline characteristics, angiographic severity, WIfI stage, Bollinger scores (whole limb, above- and below-knee), GLASS staging (global, femoropopliteal and infra-popliteal), and outcomes (technical success, bypass conversion, major amputation, and one-year mortality) were analyzed. Results: Patients were divided into diabetic (DM, n=85) and non-diabetic (NDM, n=51) groups. Diabetic patients more frequently presented with infra-inguinal stenoses >50% (55.3% vs. 35.3%, p=0.024) but fewer complete occlusions (83.5% vs. 96.1%, p=0.028). WIfI stage 1 was more common in the DM group (54.1% vs. 33.3%, p≈0.08). Bollinger scores were lower in diabetics for the whole limb (30.07±16.34 vs. 36.78±16.09, p=0.018) and below-knee segment (20.53±15.88 vs. 26.86±13.93, p=0.015). Conclusions: Diabetic CLTI is characterized by a distal angiographic pattern with predominant infra-popliteal stenoses and lower additive Bollinger scores. Segmental infra-popliteal assessment showed stronger clinical relevance than global evaluation, with below-knee Bollinger and GLASS infra-popliteal stages most closely associated with WIfI severity. These findings support a segment-focused approach in endovascular planning for diabetic patients.

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Additional Files

Published

2026-06-01

Issue

Vol. 130 No. 2 (2026): The Medical-Surgical Journal

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SURGERY

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