Implementing global chronic limb-threatening ischemia guidelines in clinical practice: Utility of the Society for Vascular Surgery Threatened Limb Classification System (WIfI)


Department of Surgery, Advocate Lutheran General Hospital


Chronic limb-threatening ischemia (CLTI) encompasses a range of ischemia, neuropathy, and tissue injury. Multiple treatment modalities are employed, treatment courses can be prolonged, and recrudescence is frequent. In 2014, the Society for Vascular Surgery Threatened Limb Classification System (WIfI) was proposed to improve the clinical staging of CLTI, to assist clinicians with assessment of amputation risk and need for revascularization. 1 The system involves grading (0-3) the three most important factors that determine the degree of limb threat, namely, wound, ischemia, and infection. Combinations of these grades were grouped by expert consensus into four clinical stages that are expected to correlate with 12-month amputation risk. Although multiple studies have since demonstrated that WIfI accurately segregates amputation risk across a range of tertiary institutional populations, it remains to be prospectively validated in large-scale registries, randomized trials, and community practice.

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