Clinical profile in lower limb arterial disease

For professional use. The result is an indicative summary to support clinical review. Combine it with physical examination, ABI/TBI, imaging, comorbidities, patient preferences and the vascular team's assessment. TASC/GLASS anatomical classes are not derived automatically.

1. Clinical presentation

Asymptomatic / incidental finding Intermittent claudication Ischaemic rest pain / tissue loss / gangrene Acute onset with suspected limb ischaemia

Define the clinical picture before interpreting the degree of stenosis.

Predominant phenotype / aetiologyDiabetes may coexist with atherosclerosis; it is not a mutually exclusive aetiology.

Walking distance (if relevant)

Impact and associated signs

Symptoms limiting activities or quality of life Ulcer or tissue loss Foot infection / possible sepsis Ischaemic rest pain Foot ulcer in a person with diabetes

Perfusion and wound parameters (if available)

ABI

Ankle pressure (mmHg)

Toe pressure (mmHg)

TcPO₂ (mmHg)

Wound duration (weeks)

WIfI stage already assigned

What does WIfI mean?

WIfI stands for Wound, Ischaemia and foot Infection: it grades wound, ischaemia and foot infection (grades 0–3) and combines them into a clinical stage 1–4, associated with the risk of limb loss and the likely benefit of revascularisation.

It applies mainly to chronic limb-threatening ischaemia. The stage does not determine treatment on its own: it must be interpreted together with anatomy, patient risk and multidisciplinary assessment. This field accepts a stage already assigned; it does not calculate it.

Global Vascular Guidelines 2019 (full text) · WIfI stage calculator

A raised or non-compressible ABI may be unreliable, especially in diabetes and kidney disease: consider toe pressure, TBI, TcPO₂ and Doppler waveforms.

2. Site and extent documented on imaging

Predominant territory

Most relevant morphology

TASC class already assigned

What does TASC mean?

TASC (TransAtlantic Inter-Society Consensus) describes the morphology and extent of arterial lesions, mainly in the aorto-iliac and femoropopliteal segments, in classes A to D of increasing complexity.

It is a historical anatomical classification that can help describe the lesion, but it does not select the technique on its own: today the choice also depends on the clinical picture, risk, complete anatomy, patient preferences and the team's resources and experience. Enter the class already assigned and state the territory in the report.

TASC II supplement: update of the classification and treatment strategies

Aorto-iliac lesions (TASC II)
Type	Criteria
A	Unilateral or bilateral stenoses of the common iliac artery (CIA) Unilateral or bilateral single short (≤3 cm) stenosis of the external iliac artery (EIA)
B	Short (≤3 cm) stenosis of the infrarenal aorta Unilateral CIA occlusion Single or multiple stenoses totalling 3–10 cm involving the EIA, not extending into the common femoral artery (CFA) Unilateral EIA occlusion not involving the origins of the internal iliac artery or the CFA
C	Bilateral CIA occlusions Bilateral EIA stenoses 3–10 cm long, not extending into the CFA Unilateral EIA stenosis extending into the CFA Unilateral EIA occlusion involving the origins of the internal iliac and/or the CFA Heavily calcified unilateral EIA occlusion, with or without involvement of the origins of the internal iliac and/or the CFA
D	Infrarenal aorto-iliac occlusion Diffuse disease involving the aorta and both iliac arteries requiring treatment Diffuse multiple stenoses involving the unilateral CIA, EIA and CFA Unilateral occlusions of both the CIA and EIA Bilateral EIA occlusions Iliac stenoses in patients with an abdominal aortic aneurysm requiring treatment and not amenable to endograft placement, or with other lesions requiring open aortic or iliac surgery

Femoropopliteal lesions (TASC II)
Type	Criteria
A	Single stenosis ≤10 cm in length Single occlusion ≤5 cm in length
B	Multiple lesions (stenoses or occlusions), each ≤5 cm Single stenosis or occlusion ≤15 cm not involving the infrageniculate popliteal artery Single or multiple lesions in the absence of continuous tibial vessels, to improve inflow for a distal bypass Heavily calcified occlusion ≤5 cm Single popliteal stenosis
C	Multiple stenoses or occlusions totalling >15 cm, with or without heavy calcification Recurrent stenoses or occlusions that need treatment after two endovascular interventions
D	Chronic total occlusion of the CFA or superficial femoral artery (>20 cm, involving the popliteal artery) Chronic total occlusion of the popliteal artery and proximal trifurcation vessels

Historical TASC II guidance: type A, endovascular treatment of choice; type B, endovascular preferred; type C, surgery preferred in good-risk patients; type D, surgery of choice. Today the choice should be individualised (ESVS 2024 and GVG 2019 guidelines).

Source: Norgren L et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg 2007;45(Suppl S):S5–S67 · Eur J Vasc Endovasc Surg 2007;33(Suppl 1):S1–S75.

GLASS stage already assigned

What does GLASS mean?

GLASS (Global Limb Anatomic Staging System) stages infrainguinal anatomy in chronic limb-threatening ischaemia. It considers the target artery path (Target Artery Path), the femoropopliteal and infrapopliteal segments and a pedal modifier; stages I–III express increasing anatomical complexity and are used to estimate the expected patency of the revascularisation path.

It should be combined with limb severity (WIfI) and patient risk (the PLAN framework). It is not intended for claudication alone or asymptomatic PAD and does not by itself indicate which procedure to perform. Enter a stage already assigned by the vascular team.

Global Vascular Guidelines 2019 (full text)

Femoropopliteal (FP) grade
Grade	Criteria
0	Mild or no significant (<50%) disease
1	Total length of superficial femoral artery (SFA) disease <1/3 (<10 cm); may include a single focal occlusion <5 cm, as long as it is not a flush occlusion; popliteal artery with mild or no significant disease
2	Total length of SFA disease 1/3–2/3 (10–20 cm); may include occlusion totalling <1/3 (<10 cm), not flush; focal popliteal stenosis <2 cm, not involving the trifurcation
3	Total length of SFA disease >2/3 (>20 cm); may include flush occlusion <20 cm or non-flush occlusion 10–20 cm; short popliteal stenosis 2–5 cm, not involving the trifurcation
4	Total length of SFA occlusion >20 cm; popliteal disease >5 cm or extending into the trifurcation; any popliteal occlusion

Infrapopliteal (IP) grade – target artery
Grade	Criteria
0	Mild or no significant (<50%) disease of the target artery
1	Focal stenosis of the tibial artery <3 cm, not involving the tibioperoneal (TP) trunk
2	Stenosis involving up to 1/3 of the target artery length; may include a single focal occlusion <3 cm, not involving the TP trunk or the target artery origin
3	Stenosis involving up to 2/3 of the target artery length; occlusion up to 1/3 of its length (may include the target artery origin, not the TP trunk)
4	Diffuse stenosis >2/3 of the target artery length; occlusion >1/3 of its length (may include the origin); any TP trunk occlusion if the anterior tibial is not the target artery

Calcification modifier: severe calcification (>50% of the circumference, diffuse, bulky or “coral reef”) increases the grade of the affected segment (FP or IP) by 1.

GLASS stage (anatomy only)
FP \ IP	IP 0	IP 1	IP 2	IP 3	IP 4
FP 4	III	III	III	III	III
FP 3	II	II	II	III	III
FP 2	I	II	II	II	III
FP 1	I	I	II	II	III
FP 0	NA	I	I	II	III

Meaning of the stages
Stage	Expected outcome of endovascular treatment
I	Low complexity: expected technical failure <10%, 1-year limb-based patency (LBP) >70%
II	Intermediate complexity: expected technical failure <20%, 1-year LBP 50–70%
III	High complexity: expected technical failure >20% and/or 1-year LBP <50%

Inframalleolar/pedal descriptor (P0–P2), reported separately and not part of the stage: P0, target artery crosses the ankle into the foot with an intact pedal arch; P1, target artery crosses into the foot but the pedal arch is absent or severely diseased; P2, no target artery crosses the ankle into the foot.

The GLASS stage describes anatomy only: it is not added to or combined with WIfI. In the GVG 2019 PLAN framework the two systems are assessed separately, together with patient risk, to decide whether and how to revascularise.

Sources: Conte MS et al. Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia. Eur J Vasc Endovasc Surg 2019;58(1S):S1–S109; J Vasc Surg 2019;69(6S):3S–125S · criteria summary: J Clin Med 2021;10:3454.

Anatomical details from the report (optional)Enter TASC and GLASS only if already assigned by a specialist: the calculator does not derive them from incomplete data.

3. Factors relevant to planning

High perioperative risk / frailty Availability of autologous vein assessed Vascular team has documented no conventional options Cardiovascular prevention therapy already optimised Structured exercise / walking programme completed without adequate response Already on an oral anticoagulant High bleeding risk / significant previous bleeding

For claudication, revascularisation is considered after an inadequate response to medical therapy and structured exercise. An oral anticoagulant or a high bleeding risk changes the antithrombotic choice.

How to read the summary

The strategy depends on the ischaemic picture, the complete anatomy, patient risk and expected benefit. In claudication, initial treatment is generally conservative, aimed at reducing cardiovascular risk and improving walking capacity; a procedure is discussed if symptoms remain limiting despite an adequate programme. In chronic limb-threatening ischaemia, prompt vascular assessment is needed to plan whether and how to revascularise.

The choice between an endovascular, open surgical or hybrid approach is individual. The tool does not assign a TASC or GLASS class and does not select the technique automatically. Spinal cord stimulation and sympathectomy/denervation are mentioned only as niche options to be discussed in selected cases with no possibility of revascularisation; they are not suggested as a standard alternative.

Clinical sources and rationale for the rules

Brazilian Society of Angiology and Vascular Surgery: peripheral arterial disease guidelines (2024) — open-access article under a CC BY licence; main source for lower-limb atherosclerosis.
ESVS 2024 Clinical Practice Guidelines on Asymptomatic Lower Limb PAD and Intermittent Claudication — published under a CC BY 4.0 licence; scope: asymptomatic disease and claudication.
IWGDF 2023: Peripheral artery disease in people with diabetes and a foot ulcer — specific pathway for diabetes and foot ulcers (joint IWGDF/ESVS/SVS guideline).
Chronic Limb-Threatening Ischemia and the Need for Revascularization (2023) — open-access review under CC BY 4.0, for the clinical context and no-option cases.

Guidelines and consensus documents applied by the engine

The recommendations of the documents listed are summarised in the clinical branches of the result, together with the reusable sources above. Pathway criteria and points of disagreement are reported without reproducing original tables or text.

ESC 2024 — Peripheral Arterial and Aortic Diseases — overall European framework, including diagnosis, management and prevention; PAD and CLTI pathway criteria applied in the result.
ACC/AHA multisociety 2024 — Lower Extremity Peripheral Artery Disease — prevention, claudication, CLTI, pathway before amputation and no-option cases.
Global Vascular Guidelines 2019 — Chronic Limb-Threatening Ischemia — WIfI, GLASS and CLTI planning; the stages are entered by the clinician.
ESVS 2020 — Management of Acute Limb Ischaemia — source for the acute branch and urgent assessment.
SICVE 2015 guidelines — Chronic obstructive aorto-iliac and lower-limb disease (in Italian) — source for pre-revascularisation imaging and assessment of anatomy and risk; PDF, Minerva Medica.
SICVE 2015 guidelines — Peripheral vascular trauma and acute limb ischaemia (in Italian) — supplementary link for the urgent branch.
TASC II 2007 — Inter-Society Consensus for the Management of Peripheral Arterial Disease — historical reference for anatomical classes; it does not on its own select today's technique.

Summary of the recommendations and clinical principles of the sources listed. The text is reworded, without reproducing tables or passages. For commercial reuse of protected sources, check permissions and licences (including CC BY 4.0). Always check the specific licence of each article and consult updates before clinical use. This tool does not replace local guidelines or the judgement of the multidisciplinary team.

Clinical profile in lower-limb arterial disease

How to read the summary

Clinical sources and rationale for the rules

Guidelines and consensus documents applied by the engine