OBJECTIVE: Patients with chronic limb-threatening ischemia (CLTI) typically undergo revascularization as the standard treatment. However, some still require major amputations post-revascularization. Because revascularization is invasive and costly, avoiding it may benefit patients with low likelihoods of wound healing. The Global Vascular Guidelines suggest primary amputation for patients unsuited to revascularization. Although previous research has linked frailty to limb prognosis, skeletal and bone frailties impact survival rather than limb outcomes. This study examines the association between sciatic nerve atrophy and limb prognosis in patients with CLTI. METHODS: This single-center, retrospective study included patients with tissue loss CLTI who underwent successful revascularizations at Kyushu Medical Center (2015-2020). Sciatic nerve cross-sectional areas (CSAs) were measured using computed tomography scans above the bifurcation of the tibial and peroneal nerves. The CSA cutoff value for predicting wound healing was established using receiver operating characteristic analysis. Patients were grouped based on whether their CSA was larger (normal) or smaller (atrophy) than CSA cutoff value. Outcomes assessed included wound healing rates, amputation-free survival (AFS), and overall survival (OS). RESULTS: Among 188 patients (226 limbs), the mean sciatic nerve CSA was 27.5 ± 0.7 mm CONCLUSIONS: Sciatic nerve atrophy correlates with poorer wound healing, AFS, and OS in patients with CLTI. Sciatic nerve assessment may guide decisions regarding limb salvage eligibility.