Abstract: This systematic review aims to synthesize the current evidence regarding the prognostic and clinical utility of the WIfI classification system in patients with PAD, focusing on its ability to predict adverse outcomes such as major amputation, mortality, and wound healing, and its integration into modern vascular diagnostic and treatment workflows. The review utilises 80 original studies with 1180954 total participants (naïve ΣN). The WIfI classification system is a vital, evidence-based tool for the clinical management of PAD, offering superior prognostic value for limb salvage and mortality compared to traditional staging systems. Systematic evidence confirms that higher WIfI stages are significantly associated with increased risks of major amputation and cardiac death, with hazard ratios reaching up to 7.54 in high-risk cohorts. While the system is robust, its clinical utility is further enhanced by integration with anatomical staging like GLASS and advanced diagnostic techniques. Future research should focus on prospective validation of WIfI-based treatment algorithms and the automation of staging through digital health solutions to improve patient outcomes in complex CLTI cases.
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Source: Semantic Scholar
Scope: All fields
Keyword Gate: Fuzzy (≥60% of required terms, minimum 2 terms matched in title/abstract)
Total Abstracts/Papers: 922
Downloaded Abstracts/Papers: 775
Included original Abstracts/Papers (all): 93
Included original Abstracts/Papers (OSMA; excl. Mixed): 80
Reference Index (links used in paper): 24
Total study participants (naïve ΣN): 1180954
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Reference Index (24)
[2] Prognostic value of Wound, Ischemia and foot Infection (WIfI) score after lower extremities bypass surgery for peripheral artery disease in chronic hemodialysis patients — https://doi.org/10.1093/eurheartj/ehad655.2074
[3] The Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification system predicts wound healing better than direct angiosome perfusion in diabetic foot wounds. — https://doi.org/10.1016/j.jvs.2018.01.060
[5] The CHADS2 score may be a useful predictor of prognosis in chronic limb-threatening ischemia patients after endovascular intervention with and without AF — https://doi.org/10.1093/eurheartj/ehad655.2054
[7] Association of cardiac prognosis in chronic limb-threatening ischemia patients after endovascular intervention and wound, ischemia, and foot infection clinical stage — https://doi.org/10.1093/eurheartj/ehac544.1962
[9] Examination of patients with diabetes mellitus and peripheral arterial disease according to the adapted ischaemic criteria of the WIfI classification — https://doi.org/10.26779/2786-832x.2024.1.16
[10] Artificial Intelligence Techniques for Prognostic and Diagnostic Assessments in Peripheral Artery Disease: A Scoping Review — https://doi.org/10.1177/00033197241310572
[19] Imaging Characterisation of Peripheral Artery Disease: A Scoping Review on Current Classifications and New Insights Brought by Artificial Intelligence — https://doi.org/10.1016/j.ejvsvf.2025.06.003
[41] Amputation-Free Survival, WIfI Stage, and GLASS Classifications in Distal Crural or Pedal Bypass for Chronic Limb-Threatening Ischemia — https://doi.org/10.3390/jcm13226649
[42] The Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification independently predicts wound healing in diabetic foot ulcers — https://doi.org/10.1016/j.jvs.2017.12.079
[43] How to Select for Angioplasty or Surgical Bypass in People With Diabetes and Peripheral Arterial Disease. — https://doi.org/10.31083/bjhm50657
[57] Podcast on How to Classify Foot Ulcers in People with Diabetes (2023 Update of the IWGDF Guidelines on Classification). — https://doi.org/10.1007/s13300-023-01521-2
[60] Clinical Outcomes of Infrapopliteal Angioplasty in Chronic Limb-threatening Ischemia: A Global Limb Anatomic Staging System Staging Perspective — https://doi.org/10.4103/ijves.ijves_118_25
[61] Evolving Paradigms in Chronic Limb-threatening Ischemia: A Systematic Review of Current and Emerging Diagnostic and Therapeutic Approaches — https://doi.org/10.1055/a-2798-9516
[64] Outcomes of severe limb ischemia with tissue loss and impact of revascularization in haemodialysis patients with wound, ischemia, and foot infection (WIfI) stage 3 or 4. — https://doi.org/10.1024/0301-1526/a000819
[65] Validation of transmetatarsal pressure as an alternative for evaluating severity of chronic limb-threatening ischemia — https://doi.org/10.1177/1358863x251346133
[71] Abstract 4147018: Predictors of Clinically Meaningful 1-Year Health Status Improvements Following Endovascular or Surgical Revascularization: Insights from the BEST-CLI Trial — https://doi.org/10.1161/circ.150.suppl_1.4147018
[75] Abstract 13060: Nutritional Status is Associated With Cardiac Death in Patients With Chronic Limb-Threatening Ischemia Undergoing Endovascular Intervention — https://doi.org/10.1161/circ.148.suppl_1.13060
