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Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) Correlates Better Than the Society for Vascular Surgery Lower Extremity Threatened Limb Classification Based on Wound, Ischemia, and Foot Infection (WIfI) in Predicting Major Amputation
Caitlin M. Sorensen, MS, Steven D. Abramowitz, MD, Rajesh K. Malik, MD, Misaki M. Kiguchi, MD, Cameron M. Akbari, MD, Edward Y. Woo, MD, Tareq M. Massimi, MD.
MedStar Washington Hospital Center, Washington, DC, USA.
The purpose of this study is to evaluate whether the clinically-based Society for Vascular Surgery (SVS) Wound, Ischemia, and Foot Infection (WIfI) classification system correlates with meaningful clinical and limb salvage outcomes for patients presenting with critical limb ischemia (CLI) as opposed to the anatomically-based TASC II classification.
A prospectively maintained single-center retrospective database was created for patients presenting with CLI who were evaluated by an interdisciplinary team of vascular and podiatric surgery. Risk stratification using the WIfI classification system separated patients into very low, low, moderate, and high-risk cohorts (class 1-4). These patients were further characterized by TASC II infrainguinal disease (A-D). Inclusion criteria consisted of patients who were evaluated and underwent revascularization and podiatric intervention for the purposes of limb salvage. Follow-up appointments were reviewed and healing times were recorded, along with subsequent interventions and dates of major amputation.
81 patients with CLI within the study period were identified. A total of 31% of patients eventually underwent amputation (25/81). 64% patients presented as high-risk (Class 4).
WIfI Classification and Rates of Amputation
WIfI presentation did not vary significantly in rate of amputation (p=0.113). A significant difference existed only when comparing high risk (class 4) against all other classes (1-3) (p=0.0137, OR 4.23 RR 2.93).
TASC II Classification and Rates of Amputation
TASC II infrainguinal lesion classification had a statistically different rate of amputation (p=0.001). In particular, when comparing TASC II A lesions vs TASC II D lesions using Fisher’s Exact Test, TASC II D lesions were 35 times more likely to result in amputation than TASC II A lesions (p=0.012, OR 35).
TASC II Classification and WIfI classification
No combination of infrainguinal TASC II classification with WIfI classification produced any significant association in rates of amputation (p= 0.385).
Increasing WIfI classification severity may not directly correlate with an increased likelihood of major amputation. Classification based on anatomic criteria may have better predictive value. Further work must be done to combine anatomic and clinical classification in order to improve clinical usefulness.
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