Simons JP, et al. - Given the critical influence of accurate survival prediction on decision-making in caring for patients with chronic limb-threatening ischemia (CLTI), researchers sought to develop validated survival models for patients with CLTI. They used only preoperative variables to generate Cox survival models. They separately modeled survival at 30 days, 2 years, and 5 years. They defined patients as low risk (30-day survival >97% and 2-year survival >70%), medium risk (30-day survival 95%-97% or 2-year survival 50%-70%), and high-risk (30-day survival <95% or 2-year survival <50%). They identified 38,470 unique CLTI patients from the Vascular Quality Initiative; of these, 63% (n = 24,214) underwent endovascular intervention and 37% (n = 14,256) underwent infrainguinal bypass. The low-, medium-, and high-risk groups had 84%, 10%, and 6.5% of the patients, respectively. Endovascular intervention was significantly less performed on patients in the low-risk group compared with those in the high-risk group. The three models had similar independent predictors of death, with greatest magnitude of effect associated with age >80 years, oxygen-dependent chronic obstructive pulmonary disease, stage 5 chronic kidney disease, and bedbound status. The models demonstrated good performance and can differentiate patients into low-, medium-, and high-risk groups to aid evidence-based revascularization recommendations that are consistent with current treatment guidelines.