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WIfI Classification-Based Analysis Of Risk Factors For Outcomes In Patients With Chronic Limb-Threatening Ischemia After Endovascular Revascularization Therapy

  • Author Footnotes
    # Zheng Chen and Tze-Woei Tan contributed equally to this article and shared co-first authorship.
    Zheng Chen
    Footnotes
    # Zheng Chen and Tze-Woei Tan contributed equally to this article and shared co-first authorship.
    Affiliations
    Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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  • Author Footnotes
    # Zheng Chen and Tze-Woei Tan contributed equally to this article and shared co-first authorship.
    Tze-Woei Tan
    Footnotes
    # Zheng Chen and Tze-Woei Tan contributed equally to this article and shared co-first authorship.
    Affiliations
    Division of Vascular Surgery, Department of Surgery, University of Arizona College of Medicine, Tucson, AZ
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  • Yu Zhao
    Affiliations
    Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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  • Chuli Jiang
    Affiliations
    Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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  • Qiu Zeng
    Affiliations
    Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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  • Gaoxiang Fan
    Affiliations
    Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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  • Wei Zhang
    Affiliations
    Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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  • Fenghe Li
    Correspondence
    Correspondence: , Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, 1 N. Youyi Street, Chongqing, 400016 China.
    Affiliations
    Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
    Search for articles by this author
  • Author Footnotes
    # Zheng Chen and Tze-Woei Tan contributed equally to this article and shared co-first authorship.
Published:December 30, 2022DOI:https://doi.org/10.1016/j.ejvs.2022.12.027
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      Abstract

      Objectives

      Evaluating limb status with WIfI classifications and assessing patient risks combined with systemic factors were recommended in patients with chronic limb-threatening ischemic (CLTI). However, there was little application evidence of WIfI in the Chinese population. This study aimed to verify the utilization of the WIfI classification in a China patient population, and further identify local and systemic independent predictors for adverse outcomes of CLTI.

      Methods

      A total of 474 patients who underwent endovascular therapy (EVT) for CLTI in a tertiary hospital between July 2017 and September 2020 were included in this retrospective study. The outcomes included 1-year major adverse limb events (MALEs), 1-year all-cause mortality, and 1-year amputation-free survival (AFS). Cox regression was used to analyze the association between risk factors and adverse outcomes.

      Results

      There were 104 (21.9%) all-cause mortalities observed. The MALEs rate was 17.5%, while AFS rate was 71.9%. The multivariate analysis revealed that a BMI < 18.5 kg/㎡ (P = .002), a left ventricular ejection fraction (LVEF) < 50 % (P < .001), and WIfI-Wound Grade (P < .001) were independent risk factors for MALEs, while age ≥ 77 years (P = .031), a BMI < 18.5 kg/㎡ (P < .001), coronary heart disease (P = .040), and WIfI clinical stages (P = .021) were independent risk factors for mortality in CLTI patients. Besides, age ≥ 77 years (P = .003), a BMI < 18.5 kg/㎡ (P < .001), coronary heart disease (P = .012), a LVEF < 50 % (P < .001), WIfI-Wound Grade (P = .004) and WIfI clinical stages (P = .044) were independently associated with a decreased AFS rate.

      Conclusions

      This study confirms the predictive ability of WIfI classification for Chinese CLTI patients who underwent EVT. Wound grade was the most sensitive and important risk factor among the three components of WIfI. In addition, systemic factors should also be considered to ensure a more accurate prognosis prediction and appropriate clinical decision-making in CLTI patients.

      Keywords

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