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Ticketed Event

Poster Competition

(PC078) Improvement in WIfI Ischemia Grade Lowers Risk for Major Amputation Following Revascularization for Chronic Limb Threatening Ischemia

Friday, June 6, 2025
12:30 PM - 2:00 PM CT

    Submitting & Presenting Author(s)

  • Benjamin S. Brooke, MD, PhD

    Chief, Division of Vascular Surgery
    University of Utah Health, Salt Lake City, UT USA
    Park City, Utah

    • Co-Author(s)

  • GD

    Gheorghe Doros

    Professor of Biostatistics
    Boston University, School of Public Health, Boston, MA USA

  • Maarit Venermo, MD, PhD

    Professor of Vascular Surgery
    Department of Vascular Surgery, University of Helsinki; Helsinki University Hospital, Helsinki, Finland
    Helsinki University
    Helsinki

  • Andres Schanzer, MD (he/him/his)

    Professor
    UMass Chan Medical School
    Worcester, Massachusetts

  • PG

    Philip P. Goodney, MD, MS

    Attending Vascular Surgeon, Section Chief
    Dartmouth Hitchcock Medical Center
    Lebanon, New Hampshire

  • Peter A. Schneider, MD

    Professor of Surgery
    Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, CA, USA
    San Francisco, California

  • Jeffrey J. Siracuse, MD, MBA

    Professor of Surgery and Radiology, Chief of Vascular and Endovascular Surgery
    Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
    Boston, Massachusetts

  • Ahmed M. Abou-Zamzam, Jr., MD (he/him/his)

    Professor and Chair
    Division of Vascular Surgery, Loma Linda University Health, Loma Linda, CA, USA
    Loma Linda, California

  • HD

    Hasan H. Dosluoglu

    Professor of Surgery
    Vascular Surgery, Jacobs School of Medicine and Biomedical Sciences, SUNY at Buffalo, NY USA
    Buffalo, New York

  • Raghu L. Motaganahalli, MD

    Professor of Surgery
    Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
    Indianapolis, Indiana

  • MS

    Michael B. Strong

    Senior National Trial Manager
    Division of Vascular and Endovascular Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
    Boston, Massachusetts

  • KR

    Kenneth Rosenfield

    Section Head for Vascular Medicine and Intervention
    Massachusetts General Hospital, Harvard Medical School, Boston, MA
    Boston, Massachusetts

  • Matthew T. Menard, MD

    Professor of Surgery
    Division of Vascular and Endovascular Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
    Lincoln, Massachusetts

  • AF

    Alik Farber, MD, MBA

    Professor of Surgery
    Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
    Boston, Massachusetts

    • Senior Author(s)

  • Michael S. Conte, MD

    Professor and Chief
    Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, CA, USA
    San Francisco, California

Objectives: Improving limb perfusion is a central objective for patients undergoing revascularization for chronic limb threatening ischemia (CLTI). However, the importance of achieving this hemodynamic goal relative to other factors that impact the risk of major amputation is unknown. This study was designed to evaluate changes in Society for Vascular Surgery Wound, Ischemia and foot Infection (WIfI) ischemia grade as a predictor of major amputation after open and endovascular revascularization in the Best Endovascular versus Best Surgical Therapy in Patients with CLTI (BEST-CLI) trial.

Methods: We conducted a secondary analysis of patients with CLTI who underwent surgical bypass and endovascular therapy as part of the prospective, randomized BEST-CLI Trial (intention to treat cohorts 1 and 2) and were alive at 1 year following surgery. Baseline patient demographics and comorbidities were evaluated along with limb-specific data classified according to WIfI before and after lower extremity revascularization. Multivariable Cox regression models were used to assess the effect of change in WIfi ischemia grade on the rate of major amputation while adjusting for perioperative factors.

Results: Among 785 patients with CLTI, 629 (80%) achieved an improvement in their WIfI ischemia grade within 30 days after undergoing surgical and endovascular interventions. Patients who achieved an improved ischemia grade after revascularization were younger but more likely to be a current smoker, have lower baseline ankle-brachial indices, and have tissue loss with a higher overall WIfI stage at the time of surgery as compared to patients with worsening or no improvement in limb perfusion (P < 0.05 for all comparisons). The incidence of major amputation at 1 year following revascularization occurred in 109 (14%) patients and was higher among those with baseline WIfI stage of 3 and 4 (vs. 1 or 2) and patients with WIfI ischemia grades that worsened or stayed the same after surgery (Figure 1). Patients who improved their WIfI ischemia grade after revascularization had a significantly lower likelihood of major amputation (Hazard Ratio (HR): 0.27, 95%CI:0.18-0.41; P< 0.001) after controlling for comorbidities, baseline WIfI stage, levels of occlusive disease, and type of revascularization (Table I).

Conclusions: Achieving early improvement in limb perfusion based on WIfI ischemia grade is a critical factor that predicts need for major amputation following revascularization. These data suggest that early changes in WIfI ischemia scores after open and endovascular interventions should be closely monitored to determine risk of CLTI progression and need for major amputation.