Background: Chronic limb-threatening ischemia (CLTI) patients often experience severe complications that can lead to amputation. Advances in revascularization techniques aim to improve patient outcomes, however the efficacy of direct versus indirect approaches remains under evaluation. Objectives: This study aimed to compare direct and indirect revascularization techniques in CLTI patients and to assess outcomes over a 12-month follow-up period. The study also considered angiosome-based ulcer classification, demographic factors, and atherosclerosis risk factors. Patients and methods: A prospective cohort of 46 CLTI patients was divided into two equal groups based on the revascularization technique: Direct (n=23) and indirect (n=23). Clinical outcomes assessed included amputation-free survival, major adverse limb events (MALE), and wound healing rates. Results: The direct group had a significantly higher amputation-free survival rate (91.3%) compared to the indirect group (69.6%, p=0.03). Freedom from MALE was also higher in the direct group (87% vs. 56.5%, p=0.02), as was the major amputation-free rate (91.3% vs. 73.9%, p=0.05). Wound healing rates were notably better in the direct group (82.6% vs. 52.2%, p=0.02). Kaplan-Meier analysis highlighted superior survival curves for amputation-free survival, MALE, and major amputation rates in the direct group. Conclusion: Direct revascularization techniques offer superior outcomes in amputation-free survival, MALE, and wound healing for CLTI patients compared to indirect techniques.