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A Single-center Experience: Clinical Profile, Management Approaches, and Limb Salvage Results in Patients with

Sharanya Vijay1, Vinayak S Shimbi1, Nabagata Mukherjee2

  • 1Department of General Surgery, Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka, India.

Annals of African Medicine
|July 16, 2026
PubMed

Insights

The Wound, Ischemia, and foot Infection (WIfI) classification better predicts limb salvage in chronic limb-threatening ischemia (CLTI) patients than the Global Limb Anatomic Staging System (GLASS). WIfI is crucial for assessing amputation risk and guiding patient care.

Area of Science:

  • Vascular Surgery
  • Peripheral Arterial Disease
  • Limb Salvage Outcomes

Background:

  • Chronic limb-threatening ischemia (CLTI) is the most severe form of peripheral arterial disease, leading to high amputation and mortality rates.
  • Effective patient stratification is crucial for managing CLTI and optimizing treatment strategies.

Purpose of the Study:

  • To classify infrainguinal arterial disease using the Global Limb Anatomic Staging System (GLASS).
  • To evaluate limb-based outcomes based on both GLASS and Wound, Ischemia, and foot Infection (WIfI) classifications in CLTI patients undergoing revascularization.
  • To compare the prognostic capabilities of GLASS and WIfI in predicting limb salvage.

Main Methods:

  • A prospective observational study of 300 consecutive CLTI patients undergoing infrainguinal revascularization over 24 months.
  • Patients were pre-interventionally classified using GLASS (Stage I-III) and WIfI (Stage 1-4) systems.
  • Primary outcome was 6-month limb salvage; secondary outcomes included amputation rates, wound healing, and mortality.

Main Results:

  • The majority of patients presented with advanced disease (Rutherford Category 6 and WIfI Stage 3-4).
  • Overall 6-month limb salvage was 85.3%. WIfI classification showed significant prognostic value (Stage 1-2: 100%, Stage 3: 85.3%, Stage 4: 78.1%; P < 0.001).
  • GLASS stages did not significantly correlate with limb salvage rates (P = 0.412), while WIfI demonstrated superior stratification.

Conclusions:

  • The Wound, Ischemia, and foot Infection (WIfI) classification is a superior predictor of limb salvage in South Indian CLTI patients compared to the Global Limb Anatomic Staging System (GLASS).
  • GLASS is useful for anatomic treatment planning, but WIfI stage is the dominant factor for predicting amputation risk.
  • WIfI facilitates evidence-based patient counseling and resource allocation for CLTI management.
Abstract

Keywords:
Amputationartériopathie périphériquecritical limb ischemiaischemiaischémieischémie critique des membresperipheral arterial diseaseprocédures de chirurgie vasculairevascular surgical procedures

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