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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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Article info
Publication history
Accepted:
December 23,
2022
Received in revised form:
November 30,
2022
Received:
March 7,
2022
Publication stage
In Press Accepted ManuscriptIdentification
Copyright
© 2022 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.
