Dynamic changes in WIfI classification as a prognostic indicator for midterm outcomes in CLTI patients undergoing infrapopliteal endovascular revascularization

OBJECTIVE: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.