Recent expansion of endovascular techniques for the treatment of infrapopliteal artery disease has increased the expectation to realistically provide a safer, easier, quicker and effective therapy for many patients with critical limb ischaemia (CLI). Nevertheless, due to the limited numbers, spread among a variety of different techniques, centres and diseases (extension and severity) and the recent introduction (not allowing to validate durability of the results), these novel approaches have still not proved to substantially improve outcomes and remain under investigation in ongoing studies. Periprocedural risk exposure and predictability of success/ failure for the leg with these new approaches in CLI patients remain largely uncertain. Failure rate of distal leg revascularisation techniques relies on several factors (location, extension and severity of artery lesion, run-off status, plantar arch integrity, calcification, diabetes, local status, infection, gangrene, etc.) or, most likely, on a combination of these. A number of scoring systems have been usefully applied to predict outcome after aortic aneurysm or cardiac surgery, while similar methods are lacking in the more challenging field of revascularisation in the legs, with only a few recently conceived.1 In this issue of EJVES, a Japanese experience from Iida et al. proposed a new anatomical score to predict the 2-year major adverse limb event (MALE), defined as freedom from major amputation or any re-intervention after angioplasty of isolated infrapopliteal lesions in patients with CLI.2 By using this score system adopted from cardiac experience (SYNTAX angiographic score for coronary vessel)3 and thereby including only anatomical predictability criteria, the authors were able to individuate limbs with infrapopliteal lesions at high likelihood of unsuccessful endovascular treatment. According to Iida et al. lesion calcification, target vessel diameter 300 mm and no below-the-ankle run-off were positively associated with MALE by multivariate analysis. Over a total of 1057 infrapopliteal angioplasty procedures, freedom fromMALE at 2 years rates were 59% in limbs with only one of these adverse risk factors, but only 29% for limbs with three or four adverse predictors. Even though the authors tested exclusively simple balloon angioplasty and nomore sophisticated techniques for infrapopliteal revascularisation, their system scoremay help identify legs with CLI that can improve less from endovascular therapy and should be