Correlating WIfI scores, rate of amputation and wound healing following lower extremity revascularization
Kristy Wiebke, DO, Mariella Gastanaduy, Charles Sternbergh, MD, FACS, Hernan Bazan, MD, FACS, Clayton Brinster, MD, Taylor Smith, MD, FACS.
Ochsner Clinic, New Orleans, LA, USA.
OBJECTIVES: Our aim was to evaluate the effectiveness of the SVS WIfI classification system (Wound extent, Ischemia, foot Infection) in predicting amputation rate, time to wound healing and subsequent revascularizations in patients with critical limb ischemia (CLI).
METHODS: This is a single-institution, retrospective analysis of patients presenting with critical limb ischemia (CLI) who underwent lower extremity (LE) revascularization from January 2012 to July 2015. All CLI patients were assigned a WIfI score based on wound status, ischemia and foot infection at the time of initial presentation for revascularization. Demographics, time to wound healing, rate of amputation and number of subsequent interventions were analyzed.RESULTS: Between January 2012 and July 2015, 284 patients underwent LE revascularization (116 endovascular, 50 open, 2 hybrid). 102 patients were excluded, leaving 182 patients in our cohort. Patients were stratified based on WIfI scores and risk of amputation. 9 (5%) were classified as Very Low (VL), 62 (34%) as Low (L), 32 (17.5%) as Medium (M), and 79 (43.5%) as High (H) risk. Demographics were similar between groups. 33 (18%) CLI patients required amputation either above or below knee. Logistical regression demonstrated a significantly higher risk of major amputation only between the L (4.8%) and H risk (29.1%) categories (p < 0.0001). 140 patients presented with tissue loss, of which 119 (85%) experience wound healing after revascularization. A significant correlation between WIfI score and wound healing (p < 0.0001) was seen, however, there was no statistical significance between cohorts. A trend was seen between WIfI and additional revascularization;22% of VL, 46.7% of L, 62% of M, and 24% of H patients required additional revascularization, though the results were not statistically significant.CONCLUSIONS: Our results are consistent with previous reports that SVS WIfI scores correlate with rates of major amputation. However, statistical significance was only found when comparing the Low and High risk WIfI categories; likely due to the small sample size (only 9 patient in VL cohort). Time to wound healing correlated with WIfI scores, however, no statistical significance was seen between the risk classifications. While trends exist between WIfI scoring and rates of major amputation exist additional multi-institutional studies are needed to obtain a sample size large enough to fully validate the outcomes predicted by the SVS expert panel.
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