BACKGROUND: Chronic limb-threatening ischemia (CLTI) represents the most severe form of peripheral arterial disease, associated with high rates of amputation and mortality. AIM: The aim of this study was to classify infrainguinal arterial disease according to the Global Limb Anatomic Staging System (GLASS) staging and evaluate limb-based outcomes according to both GLASS and Wound, Ischemia, and foot Infection (WIfI) classifications in patients undergoing revascularization for CLTI at a tertiary vascular center in South India. MATERIALS AND METHODS: This prospective observational study enrolled 300 consecutive CLTI patients undergoing infrainguinal revascularization over 24 months. Patients were classified according to GLASS (Stage I-III) and WIfI (Stage 1-4) systems preintervention. The primary outcome was limb salvage at 6 months. Secondary outcomes included major amputation rate, wound healing time, mortality, and amputation-free survival. Statistical analysis compared outcomes across classification stages. RESULTS: The mean patient age was 63.4 ± 12.1 years; 82.4% were male and 78.2% diabetic. Most patients presented with Rutherford Category 6 disease (68.1%) and WIfI Stage 3-4 (79.5%). GLASS distribution was Stage I (28.6%), Stage II (60.9%), and Stage III (10.5%). Endovascular therapy was performed in 80.7% of cases. Overall, 6-month limb salvage was 85.3%, with no significant difference across GLASS stages (I: 83.3%, II: 87.4%, and III: 82.4%; P = 0.412). However, WIfI classification demonstrated superior stratification: Stage 1-2 achieved 100% limb salvage, Stage 3 - 85.3%, and Stage 4 - 78.1% (P < 0.001). The major amputation rate was 10.9%, and the mean wound healing time was 2.96 ± 0.9 months. CONCLUSION: WIfI classification provides superior prognostic stratification for limb salvage compared to GLASS classification in South Indian CLTI patients. While GLASS effectively guides anatomic treatment planning, the WIfI stage is the dominant predictor of amputation risk, facilitating evidence-based patient counseling and resource allocation.
Vijay et al. (Wed,) studied this question.