Evidence map›Paper›PMID 41638549›Full record

ArticleEuropean journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery2026

Early Improvement in Wound, Ischaemia, and foot Infection (WIfI) Ischaemia Grade Lowers Risk of Major Amputation following Revascularisation for Chronic Limb Threatening Ischaemia.

Benjamin S Brooke, Gheorghe Doros, Maarit Venermo, Jeffrey J Siracuse, Ahmed M Abou-Zamzam, Hasan H Dosluoglu, Raghu L Motaganahalli, Matthew T Menard, Alik Farber, Michael S Conte

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Article in European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

10 authors.

Benjamin S BrookeDivision of Vascular Surgery, Department of Surgery, University of Utah Health, Salt Lake City, UT, USA. Electronic address: https://twitter.com/BenjaminSBrooke.
Gheorghe DorosBoston University, School of Public Health, Boston, MA, USA.
Maarit VenermoDepartment of Vascular Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
Jeffrey J SiracuseDivision of Vascular and Endovascular Surgery, Department of Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
Ahmed M Abou-ZamzamDivision of Vascular Surgery, Loma Linda University Health, Loma Linda, CA, USA.
Hasan H DosluogluVascular Surgery, Jacobs School of Medicine and Biomedical Sciences, SUNY at Buffalo, Buffalo, NY, USA.
Raghu L MotaganahalliDivision of Vascular Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Matthew T MenardDivision of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Alik FarberDivision of Vascular and Endovascular Surgery, Department of Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
Michael S ConteDivision of Vascular and Endovascular Surgery, University of California San Francisco, San Francisco, CA, USA.

Funding

BEST-CLI Trial-DCCU01HL107407 · NHLBI · NEW ENGLAND RESEARCH INSTITUTES, INC. · PI ASSMANN, SUSAN FERA, CZIRAKY, MARK J. · 2013 to 2019
$20.0M
BEST-CLI Trial-CCC-LeadU01HL107352 · NHLBI · BRIGHAM AND WOMEN'S HOSPITAL · PI FARBER, ALIK, MENARD, MATTHEW THOMAS · 2013 to 2018
$6.1M
BEST-CLI Trial - Cost-Effectiveness of Treatments for Critical Limb IschemiaU01HL115662 · NHLBI · BRIGHAM AND WOMEN'S HOSPITAL · PI CHOUDHRY, NITEESH K · 2013 to 2018
$1.2M
NHLBI NIH HHS U01 HL107352NHLBI NIH HHS U01 HL107407NHLBI NIH HHS U01 HL115662
6 · The paper itself

Abstract

objectiveThe Wound, Ischaemia, and foot Infection (WIfI) staging system for chronic limb threatening ischaemia (CLTI) predicts outcomes after revascularisation, but individual components of WIfI have not been evaluated. This study was designed to evaluate changes in WIfI ischaemia grade as a predictor of major amputation after open and endovascular revascularisation in the Best Endovascular versus Best Surgical Therapy in Patients with CLTI (BEST-CLI) trial.

methodsA secondary analysis was conducted of patients with CLTI randomised to surgical bypass or endovascular therapy as part of the BEST-CLI trial with available WIfI ischaemia scores at baseline and one month post-procedure. Risk adjusted Cox regression models were used to assess the effect of change in WIfI ischaemia grade on the rate of major amputation, while controlling for potential confounders.

resultsAmong 785 patients with CLTI who underwent revascularisation and were alive at one year, 629 (80.1%) achieved improvement in their WIfI ischaemia grade within 30 days after undergoing surgical and or endovascular interventions. Patients with improved ischaemia grade were younger and were more likely to smoke, have lower baseline ankle brachial indices, and have a worse overall WIfI stage at the time of revascularisation compared with patients with worsening or no improvement in limb perfusion (p < .050 for all comparisons). The major amputation incidence at one year was 14% and was increased among those with higher baseline WIfI stage (3/4 vs. 1/2) and with unchanged or worse WIfI ischaemia grade after revascularisation. Patients with improved WIfI ischaemia grade early after revascularisation had a statistically significantly lower likelihood of major amputation at one year (hazard ratio 0.27, 95% confidence interval 0.18 - 0.41; p < .001) after risk adjustment.

conclusionAchieving early improvement in limb perfusion based on WIfI ischaemia grade predicts major amputation following revascularisation independent of other risk factors. Changes in ischaemia grade after interventions should be closely monitored to determine the adequacy of revascularisation, risk of CLTI progression, and need for major amputation.

Indexed as

AmputationChronic limb threatening ischaemiaPeripheral arterial diseaseRisk assessmentWIfI

Identifiers

PMID41638549
PMCPMC13501548

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.