目的:血管外科创伤学会,缺血,和足部感染(WIfI)分类系统旨在对患有慢性威胁肢体缺血(CLTI)的患者进行风险分层,预测截肢率和血运重建的需要。然而,目前尚不清楚该系统的实际使用情况,以及该系统是否能准确预测开放式血运重建和外周干预后的结局.因此,我们试图确定在当代全州协作中采用WIfI分类系统以及患者因素的影响,以及短期和长期结果的WIfI风险评估。
方法:使用来自大型全州协作的数据,我们确定了CLTI患者在2016-2022年间接受开放手术血运重建或外周血管介入治疗(PVI).主要暴露为术前临床WIfI阶段。根据SVS下肢威胁肢体分类系统将患者分为临床WIfI阶段1、2、3或4。主要结果是30天和1年截肢和死亡率。进行多变量逻辑回归以估计WIfI分期与血运重建后结果的相关性。
结果:在17,417名患者的队列中,83.4%(n=14,529)有WIfI阶段记录。对57.6%的患者进行了外周血管干预(PVIs),42.4%接受了开放性手术血运重建(OSR)。49.5%的患者被分类为1期,19.3%为2期,12.8%为3期,18.3%的患者符合4期标准。3期和4期患者的糖尿病发病率更高,充血性心力衰竭,肾功能衰竭,并且不太可能是现在或以前的吸烟者。一半的3期患者接受了OSR,而1期患者最有可能接受过PVI(64%).随着WIfI分期从1增加到4,1年死亡率从12%增加到21%(p<0.001),30天截肢率从5%增加到38%(p<0.001),1年截肢率从15%上升到55%(p<0.001)。最后,未进行WIfI评分分类的患者的30天和1年死亡率明显较高,以及更高的30天和1年截肢率。
结论:血管外科学会WIfI临床分期与下肢血管重建术后CLTI患者1年截肢率显着相关。由于近55%的4期患者需要在干预后一年内进行大截肢,本研究支持将WIfI分类系统用于CLTI患者的临床决策.
OBJECTIVE: The Society for Vascular Surgery (SVS) Wound, Ischemia, and foot Infection (
WIfI) classification system aims to risk stratify patients with chronic limb-threatening ischemia (CLTI), predicting both amputation rates and the need for revascularization. However, real-world use of the system and whether it predicts outcomes accurately after open revascularization and peripheral interventions is unclear. Therefore, we sought to determine the adoption of the
WIfI classification system within a contemporary statewide collaborative as well as the impact of patient factor, and
WIfI risk assessment on short- and long-term outcomes.
METHODS: Using data from a large statewide collaborative, we identified patients with CLTI undergoing open surgical revascularization or peripheral vascular intervention (PVI) between 2016 and 2022. The primary exposure was preoperative clinical
WIfI stage. Patients were categorized according to the SVS Lower Extremity Threatened Limb Classification System into clinical WIfI stages 1, 2, 3, or 4. The primary outcomes were 30-day and 1-year amputation and mortality rates. Multivariable logistic regression was performed to estimate the association of WIfI stage on postrevascularization outcomes.
RESULTS: In the cohort of 17,417 patients, 83.4% (n = 14,529) had
WIfI stage documented. PVIs were performed on 57.6% of patients, and 42.4% underwent an open surgical revascularization. Of the patients, 49.5% were classified as stage 1, 19.3% stage 2, 12.8% stage 3, and 18.3% of patients met stage 4 criteria. Stage 3 and 4 patients had higher rates of diabetes, congestive heart failure, and renal failure, and were less likely to be current or former smokers. One-half of stage 3 patients underwent open surgical revascularization, whereas stage 1 patients were most likely to have received a PVI (64%). As WIfI stage increased from 1 to 4, 1-year mortality increased from 12% to 21% (P < .001), 30-day amputation rates increased from 5% to 38% (P < .001), and 1-year amputation rates increased from 15% to 55% (P < .001). Finally, patients who did not have WIfI scores classified had significantly higher 30-day and 1-year mortality rates, as well as higher 30-day and 1-year amputation rates.
CONCLUSIONS: The SVS WIfI clinical stage is significantly associated with 1-year amputation rates in patients with CLTI after lower extremity revascularization. Because nearly 55% of stage 4 patients require a major amputation within 1 year of intervention, this finding study supports use of the WIfI classification system in clinical decision-making for patients with CLTI.