Wound, Ischemia, Foot Infection (Wifi) Classification System And Its Predictive Ability Concerning Amputation-Free Survival, Mortality And Major Limb Amputation In A Portuguese Population: A Single Center Experience

Authors

  • Duarte Gil Alves General Surgery Department, Hospital Dr. Nélio Mendonça https://orcid.org/0000-0001-8183-6827
  • Vítor Ferreira Angiology and Vascular Surgery Department, Centro Hospitalar do Tâmega e Sousa
  • Gabriela Teixeira Angiology and Vascular Surgery Department, Centro Hospitalar do Tâmega e Sousa https://orcid.org/0000-0003-0077-7322
  • João Vasconcelos Angiology and Vascular Surgery Department, Centro Hospitalar do Tâmega e Sousa
  • Miguel Maia Angiology and Vascular Surgery Department, Centro Hospitalar do Tâmega e Sousa
  • José Vidoedo Angiology and Vascular Surgery Department, Centro Hospitalar do Tâmega e Sousa https://orcid.org/0000-0002-5061-4145
  • João Almeida Pinto Angiology and Vascular Surgery Department, Centro Hospitalar do Tâmega e Sousa

DOI:

https://doi.org/10.48729/pjctvs.364

Keywords:

Ischemia, Foot Ulcer, Infection, Diabetic foot, Amputation, Peripheral Arterial Disease

Abstract

Introduction: Commonly used chronic limb-threatening ischemia (CLTI) classifications lack granularity and detail to precisely stratify patients according to risk of limb loss, expected revascularization benefit and mortality. The aim of this study is to evaluate in a Portuguese population the prognostic value of an updated CLTI classification based on Wound, Ischemia, and foot Infection (WIfI) proposed by the Society for Vascular Surgery.
Materials and Methods: Single-center retrospective evaluation of prospectively collected data of consecutive patients with CLTI submitted to lower limb revascularization from January to December of 2017. All consecutive patients with chronic peripheral artery disease with ischemic rest pain or tissue loss were included. The exclusion criteria were patients with intermittent claudication, vascular trauma, acute ischemia, non-atherosclerotic arterial disease and isolated iliac intervention. The primary end-point was major limb amputation, mortality and amputation-free survival (AFS) at 30 days, 1 year and 2 year follow-up. Secondary end-points were minor amputation, wound healing time (WHT) and rate (WHR).
Results: A total of 111 patients with CLTI were submitted to infra-inguinal revascularization: 91 endovascular and 20 open surgery. After categorizing them according to the WIfI: 20 had stage 1 (18.52%), 29 stage 2 (26.85%), 38 stage 3 (35.19%) and 21 stage 4 (19.44%). Overall mortality rate was 1.8%, 17% and 22.3% at 30 days, 1 year and 2 years follow-up. Major amputation rate was 0.9%, 2.7% and 2.7% at 30 days, 1 year and 2 years follow-up. AFS rate was 97.3%, 82.1%, and 76.8% at 30 days, 1 year, 2 years follow-up. In multi-variable analysis, higher WIfI score was the only predictive factor for mortality and AFS. WIfI 3 and 4 were also associated with increased risk of non-healing ulcer.
Conclusion: This study proved the prognostic value of the WIfI classification in a Portuguese population by showing an association between higher scores and increased mortality, lower AFS and non-healing ulcer.

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Published

09-02-2024

How to Cite

1.
Alves DG, Ferreira V, Teixeira G, Vasconcelos J, Maia M, Vidoedo J, Almeida Pinto J. Wound, Ischemia, Foot Infection (Wifi) Classification System And Its Predictive Ability Concerning Amputation-Free Survival, Mortality And Major Limb Amputation In A Portuguese Population: A Single Center Experience. Rev Port Cir Cardiotorac Vasc [Internet]. 2024 Feb. 9 [cited 2024 Jun. 13];30(4):51-8. Available from: https://pjctvs.com/index.php/journal/article/view/364

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