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GLASS classification system*

Femoropopliteal segment
0	Mild or no significant (<50%) disease
1	Total length SFA disease <1/3 (<10 cm); may include single focal CTO (<5 cm) as long as not flush occlusion; popliteal artery with mild or no significant disease
2	Total length SFA disease 1/3 to 2/3 (10 to 20 cm); may include CTO totaling <1/3 (10 cm) but not flush occlusion; focal popliteal artery stenosis <2 cm, not involving trifurcation
3	Total length SFA disease >2/3 (>20 cm) length; may include any flush occlusion <20 cm or non-flush CTO 10 to 20 cm long; short popliteal stenosis 2 to 5 cm, not involving trifurcation
4	Total length SFA occlusion >20 cm; popliteal disease >5 cm or extending into trifurcation; any popliteal CTO
Infrapopliteal segment
0	Mild or no significant (<50%) disease
1	Focal stenosis <3 cm not including TP trunk
2	Total length of target artery disease <1/3 (<10 cm); single focal CTO <3 cm (not including target artery origin or TP trunk)
3	Total length of target artery disease 1/3 to 2/3 (10 to 20 cm); CTO 3 to 10 cm (may include target artery origin, but not TP trunk)
4	Total length of target artery disease >2/3 length; CTO >1/3 (>10 cm) of length (may include target artery origin); any CTO of TP trunk^¶
Infrainguinal GLASS stage (I to III)
FP grade	IP grade
FP grade	0	1	2	3	4
0	N/A	I	I	II	III
1	I	I	II	II	III
2	I	II	II	II	III
3	II	II	II	III	III
4	III	III	III	III	III

IP grading is applied only to the primary selected vessel in the TAP.
Severe calcification (eg, >50% of circumference; diffuse, bulky, or "coral reef" plaques) within the TAP increases the within-segment grade by +1.
TP trunk disease is only included if the target vessel is the posterior tibial or peroneal artery.

GLASS: Global Anatomic Staging System; SFA: superficial femoral artery; CTO: chronic total occlusion; TP: tibioperoneal; IP: infrapopliteal; FP: femoropopliteal; TAP: target arterial path.
* The GLASS classification also includes aortoiliac (inflow) staging. Stage I: Stenosis of the common and/or external iliac artery, chronic total occlusion of either common or external iliac artery (not both), stenosis of the infrarenal aorta; any combination of these. Stage II: Chronic total occlusion of the aorta; chronic total occlusion of common and external iliac arteries; severe diffuse disease and/or small-caliber (<6 mm) common and external iliac arteries; concomitant aneurysm disease; severe diffuse in-stent restenosis in the aortoiliac system.^[1]
¶ If anterior tibial is not the target artery.

Reference:

Conte MS, Bradbury AW, Kolh P, et al. Global vascular guidelines on the management of chronic limb-threatening ischemia. J Vasc Surg 2019; 69:3S.

Original table modified for this publication. From: Popplewell MA, Bradbury AW. Infrainguinal disease: Endovascular therapy. In: Rutherford's Vascular Surgery and Endovascular Therapy, 9th ed, Sidawy AN, Perler BA (Eds), Elsevier, Philadelphia 2019. Table reproduced with the permission of Elsevier Inc. All rights reserved.

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