Dynamic changes in WIfI classification as a prognostic indicator for midterm outcomes in CLTI patients undergoing...

This study aimed to evaluate the prognostic significance of early postoperative the Wound, Ischemia, and foot Infection (WIfI) stage changes in Chronic limb-threatening ischemia (CLTI) patients with infrapopliteal lesions undergoing endovascular revascularization.

A total of 153 patients with infrapopliteal occlusive CLTI who underwent endovascular revascularization were prospectively enrolled. WIfI staging was performed preoperatively and reassessed within 1-3 days after the operation. Patients were categorized into two groups based on postoperative WIfI stage changes: the "WIfI-Improved Group" (postoperative WIfI stage improved by at least one level) and the "WIfI-Non-Improved Group" (no change or worsening in postoperative WIfI stage). Clinical outcomes, including major adverse events (MAEs), amputation-free survival (AFS), mortality, and major adverse limb events (MALEs), were assessed at 1 year postoperatively.

There were no statistically significant differences between the two groups in terms of demographic data and underlying comorbidities. Patients in the WIfI-Improved Group exhibited significantly lower risks of MAEs (Log-rank, P = 0.011), improved AFS (P = 0.011), and reduced mortality (P = 0.005) compared to the WIfI-Non-Improved Group. However, no statistically significant differences in MALEs were observed between the two groups (P = 0.209).

Postoperative improvement in WIfI classification is a strong predictor of better 1-year outcomes, including reduced MAEs, improved AFS, and lower mortality, in CLTI patients undergoing infrapopliteal endovascular revascularization. Dynamic WIfI assessment can serve as a valuable tool for postoperative prognosis evaluation, risk stratification, and guiding individualized management strategies.