Department of Cardiovascular Medicine, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan.
Department of Cardiovascular Medicine, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan.
J Vasc Surg. 2018 Jun;67(6):1762-1768. doi: 10.1016/j.jvs.2017.09.037. Epub 2017 Dec 8.
The Wound, Ischemia, foot Infection (WIfI) classification system is used to predict the amputation risk in patients with critical limb ischemia (CLI). The validity of the WIfI classification system for hemodialysis (HD) patients with CLI is still unknown. This single-center study evaluated the prognostic value of WIfI stages in HD patients with CLI who had been treated with endovascular therapy (EVT).
A retrospective analysis was performed of collected data on CLI patients treated with EVT between April 2007 and December 2015. All patients were classified according to their wound status, ischemia index, and extent of foot infection into the following four groups: very low risk, low risk, moderate risk, and high risk. Comorbidities and vascular lesions in each group were analyzed. The prognostic value of the WIfI classification was analyzed on the basis of the wound healing rate and amputation-free survival at 1 year.
This study included 163 consecutive CLI patients who underwent HD and successful endovascular intervention. The rate of the high-risk group (36%) was the highest among the four groups, and the proportions of very-low-risk, low-risk, and moderate-risk patients were 10%, 18%, and 34%, respectively. The mean follow-up duration was 784 ± 650 days. The wound healing rates at 1 year were 92%, 70%, 75%, and 42% in the very-low-risk, low-risk, moderate-risk, and high-risk groups, respectively (P <.01). A similar trend was observed for the 1-year amputation-free survival among the groups (76%, 58%, 61%, and 46%, respectively; P = .02).
The WIfI classification system predicted the wound healing and amputation risks in a highly selected group of HD patients with CLI treated with EVT, with a statistically significant difference between high-risk patients and other patients.
伤口-缺血-足部感染（WIfI）分类系统用于预测重症肢体缺血（CLI）患者的截肢风险。该分类系统在接受血管内治疗（EVT）的血液透析（HD）CLI 患者中的有效性尚不清楚。本单中心研究评估了 WIfI 分期在接受 EVT 治疗的 HD-CLI 患者中的预后价值。
对 2007 年 4 月至 2015 年 12 月接受 EVT 治疗的 CLI 患者的临床数据进行回顾性分析。所有患者根据伤口状况、缺血指数和足部感染程度分为以下 4 组：极低危、低危、中危和高危。分析每组的合并症和血管病变。根据 1 年时的伤口愈合率和免于截肢的生存率分析 WIfI 分类的预后价值。
本研究纳入了 163 例接受 HD 且 EVT 成功的连续 CLI 患者。高危组（36%）的比例最高，极低危、低危和中危组的比例分别为 10%、18%和 34%。平均随访时间为 784±650 天。1 年时的伤口愈合率分别为极低危组 92%、低危组 70%、中危组 75%和高危组 42%（P<.01）。各组间 1 年免于截肢的生存率也呈现出相似的趋势（分别为 76%、58%、61%和 46%；P=0.02）。
WIfI 分类系统预测了接受 EVT 治疗的高度选择的 HD-CLI 患者的伤口愈合和截肢风险，高危患者与其他患者之间存在统计学显著差异。
