The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: risk stratification based on wound, ischemia, and foot infection (WIfI).
By J. Mills, M. Conte, D. Armstrong, F. Pomposelli, A. Schanzer, A. Sidawy, G. Andros. Journal of Vascular Surgery, 2014
1,507 citations recorded by the source corpus.
Critical limb ischemia, first defined in 1982, was intended to delineate a subgroup of patients with a threatened lower extremity primarily because of chronic ischemia. It was the intent of the original authors that patients with diabetes be excluded or analyzed separately. The Fontaine and Rutherford Systems have been used to classify risk of amputation and likelihood of benefit from revascularization by subcategorizing patients into two groups: ischemic rest pain and tissue loss. Due to demographic shifts over the last 40 years, especially a dramatic rise in the incidence of diabetes mellitus and rapidly expanding techniques of revascularization, it has become increasingly difficult to perform meaningful outcomes analysis for patients with threatened limbs using these existing classification systems. Particularly in patients with diabetes, limb threat is part of a broad disease spectrum. Perfusion is only one determinant of outcome; wound extent and the presence and severity of infection also greatly impact the threat to a limb. Therefore, the Society for Vascular Surgery Lower Extremity Guidelines Committee undertook the task of creating a new classification of the threatened lower extremity that reflects these important considerations. We term this new framework, the Society for Vascular Surgery Lower Extremity Threatened Limb Classification System. Risk stratification is based on three major factors that impact amputation risk and clinical management: Wound, Ischemia, and foot Infection (WIfI). The implementation of this classification system is intended to permit more meaningful analysis of outcomes for various forms of therapy in this challenging, but heterogeneous population.
Subfields: Endocrinology, Diabetes and Metabolism, Rehabilitation, Surgery
View Paper: https://www.semanticscholar.org/paper/0cda73e71905ce8cb7d0ef295a3505474b4629ec
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Citations in the corpus
- Challenges in the Treatment of Chronic Wounds (2015, background): “The exact roles of endovascular and open bypass procedures are still evolving, but are primarily determined by arterial anatomy, wound severity, and patient comorbidities.(67,68) The ultimate goal is to restore a palpable pulse in the affected foot.”
- The management of diabetic foot: A clinical practice guideline by the Society for Vascular Surgery in collaboration with the American Podiatric Medical Association and the Society for Vascular Medicine. (2016, background): “For the wide spectrum of other patients with diabetes or ulceration and gangrene with variable degrees of arterial insufficiency, the choice of intervention likely depends on the degree of ischemia, the extent of arterial disease, the extent of the wound, the presence or absence of infection, and th”
- Global vascular guidelines on the management of chronic limb-threatening ischemia (2019, background): “This system stratifies amputation risk according to wound extent, degree of ischemia, and presence and severity of foot infection (Wound, Ischemia, and foot Infection [WIfI]).(10) Although it may require some adjustments, WIfI appears to correlate strongly with important clinical outcomes.”