BACKGROUND: Higher systemic inflammation may portend worse limb outcomes after endovascular therapy (EVT). We assessed whether the pre‑procedural C‑reactive protein/albumin ratio (CAR) predicts major amputation (limb loss) at 1 year after EVT for symptomatic superficial femoral artery (SFA) disease. OBJECTIVE: To assess the applicability of CAR in prediction of limb salvage in patients with SFA lesion according to TASC II classification after endovascular treatment. PATIENTS AND METHODS: This Prospective observational single‑center cohort study of 40 patients at Ain Shams University Hospitals undergoing EVT for symptomatics SFA disease according to TASC II classification. Patients with active infection or non‑arterial causes of elevated CRP were excluded. The primary endpoint was major amputation at 12 months. CAR was calculated using harmonized units (CRP mg/L ÷ albumin g/L). RESULTS: The CAR was identified as an independent predictor of limb salvage after one year, among 40 patients (mean age 61.4 ± 5.03 years; 75% male), major amputation occurred in 6 (15.0%). CAR discriminated 1‑year limb loss (AUC 0.912, p<0.001). The optimal cut‑off was CAR ≥2.11, yielding sensitivity 83.33%, specificity 73.53%. Dichotomized at this threshold, high CAR was associated with markedly higher odds of limb loss. CONCLUSION: Pre-procedural CAR is a valuable prognostic marker for predicting limb salvage in patients with superficial femoral artery lesions undergoing endovascular treatment. CAR ≥2.11 identifies a small, higher‑risk subgroup with substantially increased odds of limb loss while preserving a high negative predictive value.