Validation of the WIfI classification system in nondiabetic patients treated by endovascular means for critical limb ischemia
The WIfI classification system was initially published by Dr. Mills in January 2014 at JVS. The aim of this classification is to stratify the risk of limb amputation (very low, low, moderate and high risk) based on three factors: wound, ischemia and foot infection. The following presentation represents a validation of this classification in a well-defined cohort (nondiabetic patients treated by endovascular means for critical limb ischemia).
Excellent presentation Efthymios and one of most valuable papers of our PAD working group.
Do you think that conservative treatment might be a viable treatment option for patients who are at very low amputation risk, or revascularization should be always offered regardless the WIfI risk?
Thank you for the interesting question.
According to the initial publication of WIfI from Mils at JVS (doi: 10.1016/j.jvs.2013.08.003) the estimated likelihood of benefit of revascularization for patients with a low WIfI score would be also very low. On the other hand, we do know that critical threatening limb ischemia (CTLI) is even today associated with high amputation- (approx. 20%) and morbidity rates (approx. 25%) within a year. Moreover, revascularization for limb salvage is indicated wherever feasible (recommendation IB, ESC Guidelines 2017, doi:10.1093/eurheartj/ehx095).
In my opinion, WIfI score is undoubtedly a useful evaluation tool, but for the final decision regarding revascularization or not, patients’ comorbidity index and anatomic disease pattern should be taken into consideration.